Healthcare Provider Details

I. General information

NPI: 1821526385
Provider Name (Legal Business Name): TIMOTHY CYMANSKI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 49TH ST N STE C
ST PETERSBURG FL
33710-5237
US

IV. Provider business mailing address

2150 49TH ST N STE C
ST PETERSBURG FL
33710-5237
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-0721
  • Fax: 727-327-2875
Mailing address:
  • Phone: 727-327-0721
  • Fax: 727-327-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH11014
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11014
License Number StateFL

VIII. Authorized Official

Name: TIMOTHY MICHAEL CYMANSKI
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 303-726-4558