=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083791487
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY J MCCROSSEN D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7994 COLERAIN AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45239-4512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-521-3360
-----------------------------------------------------
Fax | 513-521-7300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7994 COLERAIN AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45239-4512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-521-3360
-----------------------------------------------------
Fax | 513-521-7300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2130
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | NY007272
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------