MEDICARE: DR. TIMOTHY J CARDILE DC

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	6201	TX

General Provider Information

NPI Number	:	1255480521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY J CARDILE DC

Provider Business Mailing Address
First Line	:	314 OAK AVE
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2856
Country	:	US
Telephone Number	:	903-439-0853
Fax Number	:	903-439-0854

Provider Business Practice Location Address
First Line	:	314 OAK AVE
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2856
Country	:	US
Telephone Number	:	903-439-0853
Fax Number	:	903-439-0854

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	06/23/2008

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