MEDICARE: DR. TIMOTHY DAVID DOOLEY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4010	OH

General Provider Information

NPI Number	:	1013140664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY DAVID DOOLEY D.C.

Provider Business Mailing Address
First Line	:	1504 YANKEE PARK PL
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1878
Country	:	US
Telephone Number	:	937-424-3068
Fax Number	:	937-496-5401

Provider Business Practice Location Address
First Line	:	1504 YANKEE PARK PL
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1878
Country	:	US
Telephone Number	:	937-424-3068
Fax Number	:	937-496-5401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	01/09/2013

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