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General NPI Number Information
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NPI Number | 1679458087
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Entity Type | Individual
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Provider Name | TIMOTHY GROTHE DC
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Gender | Male
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 209 SAINT LOUIS AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-1278
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Country | US
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Telephone | 713-907-6507
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 TUCKER LN
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City | KENNEDALE
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State | TX
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Zip | 76060-1020
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Country | US
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Telephone | 713-907-6507
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Fax |
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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 | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 13013
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License Number State | TX
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