Healthcare Provider Details

I. General information

NPI: 1346636149
Provider Name (Legal Business Name): TIMOTHY EARL CUNNINGHAM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69282 HIGHWAY 59 STE 4
MANDEVILLE LA
70471-7676
US

IV. Provider business mailing address

69282 HIGHWAY 59 STE 4
MANDEVILLE LA
70471-7676
US

V. Phone/Fax

Practice location:
  • Phone: 985-951-2020
  • Fax: 985-951-2025
Mailing address:
  • Phone: 985-951-2020
  • Fax: 985-951-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number4762653906
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1775
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: