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General NPI Number Information
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NPI Number | 1568686814
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Entity Type | Individual
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Provider Name | TIMOTHY PHEASANT ANGELO D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 09/24/2016
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Provider Practice Location Address
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Address Line | 903 EMBARCADERO DR SUITE 3
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-4098
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Country | US
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Telephone | 916-933-9870
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Fax | 916-933-2708
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Provider Business Mailing Address
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Address Line | 903 EMBARCADERO DR STE 4
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-4098
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Country | US
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Telephone | 916-933-9870
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Fax | 916-933-3540
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 30036
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License Number State | CA
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