Healthcare Provider Details

I. General information

NPI: 1144226564
Provider Name (Legal Business Name): TIMOTHY A MULHOLLEM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8391 SPRING RD STE 1
NEW BLOOMFIELD PA
17068-8560
US

IV. Provider business mailing address

8391 SPRING RD STE 1
NEW BLOOMFIELD PA
17068-8560
US

V. Phone/Fax

Practice location:
  • Phone: 717-582-2120
  • Fax:
Mailing address:
  • Phone: 717-582-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC002757L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: