Healthcare Provider Details

I. General information

NPI: 1710937495
Provider Name (Legal Business Name): TIMOTHY JOHN WHELAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E 2ND AVE
MILBANK SD
57252-1814
US

IV. Provider business mailing address

235 E 2ND AVE
MILBANK SD
57252-1814
US

V. Phone/Fax

Practice location:
  • Phone: 605-432-9070
  • Fax:
Mailing address:
  • Phone: 605-432-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1006
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3595
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: