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General NPI Number Information
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NPI Number | 1104847748
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Entity Type | Organization
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Legal Business Name | TIM COINER DC INC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 777 ADDISON AVE
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City | TWIN FALLS
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State | ID
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Zip | 83301-5266
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Country | US
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Telephone | 208-736-8818
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Fax | 208-736-8828
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Provider Business Mailing Address
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Address Line | 777 ADDISON AVE
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City | TWIN FALLS
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State | ID
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Zip | 83301-5266
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Country | US
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Telephone | 208-736-8818
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Fax | 208-736-8828
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIM JOSEPH COINER
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Credential | DC
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Telephone | 208-736-8818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIA658
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License Number State | ID
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