MEDICARE: DR. TIMOTHY ALLEN HIRST 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	7699	AZ
2	111NR0400X	Rehabilitation Chiropractor	4391	AZ

General Provider Information

NPI Number	:	1518092360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY ALLEN HIRST D.C.

Provider Business Mailing Address
First Line	:	3570 S VAL VISTA DR STE 110
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7327
Country	:	US
Telephone Number	:	480-899-9923
Fax Number	:	480-899-0196

Provider Business Practice Location Address
First Line	:	3570 S VAL VISTA DR STE 110
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7327
Country	:	US
Telephone Number	:	480-899-9923
Fax Number	:	480-899-0196

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	02/01/2021

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