Healthcare Provider Details

I. General information

NPI: 1538232301
Provider Name (Legal Business Name): TIMOTHY G. PANAH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 N. MAIN ST. SUITE 7
CEDAR CITY UT
84720-9769
US

IV. Provider business mailing address

2002 N. MAIN ST. SUITE 7
CEDAR CITY UT
84720-9769
US

V. Phone/Fax

Practice location:
  • Phone: 435-867-4505
  • Fax: 435-867-4505
Mailing address:
  • Phone: 435-867-4505
  • Fax: 435-867-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number6221739-1202
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: