Healthcare Provider Details

I. General information

NPI: 1346232824
Provider Name (Legal Business Name): TIMOTHY ROGER NOBLE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5769 E SANTA ANA CANYON RD SUITE P
ANAHEIM CA
92807-3233
US

IV. Provider business mailing address

5769 E SANTA ANA CANYON RD SUITE P
ANAHEIM CA
92807-3233
US

V. Phone/Fax

Practice location:
  • Phone: 714-974-3700
  • Fax: 714-282-1830
Mailing address:
  • Phone: 714-974-3700
  • Fax: 714-282-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number18565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: