Healthcare Provider Details

I. General information

NPI: 1124272372
Provider Name (Legal Business Name): TIMBERLAND CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N HWY 414
MOUNTAIN VIEW WY
82939
US

IV. Provider business mailing address

PO BOX 895 1050 N HWY 414
MOUNTAIN VIEW WY
82939-0895
US

V. Phone/Fax

Practice location:
  • Phone: 307-782-3180
  • Fax: 307-782-3181
Mailing address:
  • Phone: 307-782-3180
  • Fax: 307-782-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number603
License Number StateWY

VIII. Authorized Official

Name: DR. RICHARD TAD GUILD
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 307-782-3180