MEDICARE: MR. TIMOTHY B PRICE 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	CH00034209	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	602288498	OTHER	WA	UNIFIED BUSINESS ID
2	CH00034209	OTHER	WA	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1639172646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY B PRICE DC

Provider Business Mailing Address
First Line	:	2020 EAST 29TH AVE.
Second Line	:	SUITE A
City	:	SPOKANE
State	:	WA
Zip	:	99203
Country	:	US
Telephone Number	:	509-455-7552
Fax Number	:	509-747-6130

Provider Business Practice Location Address
First Line	:	2020 EAST 29TH AVE.
Second Line	:	SUITE A
City	:	SPOKANE
State	:	WA
Zip	:	99203
Country	:	US
Telephone Number	:	509-455-7552
Fax Number	:	509-747-6130

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/03/2014

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Directions to “ MR. TIMOTHY B PRICE DC” Practice Location

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