Healthcare Provider Details

I. General information

NPI: 1235161456
Provider Name (Legal Business Name): TIMOTHY L SEXTON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TIMOTHY L SEXTON D.C.

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 COUNTY ROAD 218 SUITE 5
MIDDLEBURG FL
32068-4880
US

IV. Provider business mailing address

4213 COUNTY ROAD 218 SUITE 5
MIDDLEBURG FL
32068-4880
US

V. Phone/Fax

Practice location:
  • Phone: 904-282-3917
  • Fax:
Mailing address:
  • Phone: 904-282-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4491
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: