Healthcare Provider Details

I. General information

NPI: 1245386101
Provider Name (Legal Business Name): TIMOTHY DAVID STUDT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1883 W MONROE RD
SAINT LOUIS MI
48880-9789
US

IV. Provider business mailing address

1883 W MONROE RD
SAINT LOUIS MI
48880-9789
US

V. Phone/Fax

Practice location:
  • Phone: 989-681-2533
  • Fax: 989-681-2533
Mailing address:
  • Phone: 989-681-2533
  • Fax: 989-681-2533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberTS005329
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: