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General NPI Number Information
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NPI Number | 1447488077
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Entity Type | Organization
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Legal Business Name | TJW INC
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 8829 DAVIS RD SUITE 1
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City | STOCKTON
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State | CA
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Zip | 95209-1871
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Country | US
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Telephone | 209-474-0506
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Fax |
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Provider Business Mailing Address
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Address Line | 8829 DAVIS RD SUITE 1
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City | STOCKTON
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State | CA
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Zip | 95209-1871
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Country | US
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Telephone | 209-474-0506
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. TIMOTHY ADAM WALTH
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Credential | DC
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Telephone | 209-474-3764
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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 | DC014510
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License Number State | CA
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