Healthcare Provider Details

I. General information

NPI: 1982654240
Provider Name (Legal Business Name): TIMOTHY A DAVIDSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 WILLOW CIRCLE DR STE. #400
CREST HILL IL
60435-0959
US

IV. Provider business mailing address

1640 WILLOW CIRCLE DR STE. #400
CREST HILL IL
60435-0959
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-9922
  • Fax: 815-729-9933
Mailing address:
  • Phone: 815-729-9922
  • Fax: 815-729-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: