Healthcare Provider Details

I. General information

NPI: 1598743163
Provider Name (Legal Business Name): TIMOTHY ALAN SMITH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7174 ERIE RD
DERBY NY
14047-9701
US

IV. Provider business mailing address

7174 ERIE RD
DERBY NY
14047-9701
US

V. Phone/Fax

Practice location:
  • Phone: 716-947-5106
  • Fax: 716-947-9329
Mailing address:
  • Phone: 716-947-5106
  • Fax: 716-947-9329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010563-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: