Healthcare Provider Details

I. General information

NPI: 1265571921
Provider Name (Legal Business Name): TIMOTHY J ESPOSITO SR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 LOMITA BLVD
LOMITA CA
90717-1906
US

IV. Provider business mailing address

2017 AVENIDA FELICIANO
RANCHO PALOS VERDES CA
90275-1008
US

V. Phone/Fax

Practice location:
  • Phone: 310-326-2922
  • Fax:
Mailing address:
  • Phone: 310-514-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC21676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: