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General NPI Number Information
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NPI Number | 1427262633
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Entity Type | Organization
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Legal Business Name | GRAND ISLAND CHIROPRACTIC CENTER, PC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 620 N CUSTER AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4375
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Country | US
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Telephone | 308-381-1312
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Fax |
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Provider Business Mailing Address
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Address Line | 620 N CUSTER AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4375
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Country | US
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Telephone | 308-381-1312
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY L DUNAGAN
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Credential | D.C.
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Telephone | 308-381-1312
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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 | 638
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License Number State | NE
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