MEDICARE: DR. TIMOTHY G. PANAH 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	111NR0400X	Rehabilitation Chiropractor	6221739-1202	UT

General Provider Information

NPI Number	:	1538232301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY G. PANAH D.C.

Provider Business Mailing Address
First Line	:	2002 N. MAIN ST.
Second Line	:	SUITE 7
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-9769
Country	:	US
Telephone Number	:	435-867-4505
Fax Number	:	435-867-4505

Provider Business Practice Location Address
First Line	:	2002 N. MAIN ST.
Second Line	:	SUITE 7
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-9769
Country	:	US
Telephone Number	:	435-867-4505
Fax Number	:	435-867-4505

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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