=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528032869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | P SCOTT TIMKO DC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2006
-----------------------------------------------------
Last Update Date | 02/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2814 W BELL RD STE 1470
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-863-3345
-----------------------------------------------------
Fax | 602-863-0949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2814 W BELL RD STE 1470
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-863-3345
-----------------------------------------------------
Fax | 602-863-0949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. P SCOTT TIMKO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 602-863-3345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5748
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------