MEDICARE: DR. TIMOTHY A DAVIDSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	653965	OTHER	IL	ACN GROUP
2	7643227	OTHER	IL	AETNA
3	653965	OTHER	IL	ACN
4	12143864	OTHER	IL	MULTIPLAN
5	2115623	OTHER	IL	CAQH
6	9932155	OTHER	IL	BC/BS
7	P3297300	OTHER	IL	1ST HEALTH

General Provider Information

NPI Number	:	1982654240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY A DAVIDSON D.C.

Provider Business Mailing Address
First Line	:	1640 WILLOW CIRCLE DR
Second Line	:	STE. #400
City	:	CREST HILL
State	:	IL
Zip	:	60435-0959
Country	:	US
Telephone Number	:	815-729-9922
Fax Number	:	815-729-9933

Provider Business Practice Location Address
First Line	:	1640 WILLOW CIRCLE DR
Second Line	:	STE. #400
City	:	CREST HILL
State	:	IL
Zip	:	60435-0959
Country	:	US
Telephone Number	:	815-729-9922
Fax Number	:	815-729-9933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. TIMOTHY A DAVIDSON D.C.” Practice Location

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