Healthcare Provider Details

I. General information

NPI: 1326603358
Provider Name (Legal Business Name): TIMBERLINE WELLNESS CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S LINDSAY RD STE 110
GILBERT AZ
85297-1504
US

IV. Provider business mailing address

4694 S KIRBY ST
GILBERT AZ
85297-8275
US

V. Phone/Fax

Practice location:
  • Phone: 480-283-3168
  • Fax: 480-571-3062
Mailing address:
  • Phone: 480-283-3168
  • Fax: 480-571-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. COOPER ANDERSON
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 480-283-3168