MEDICARE: TIMOTHY D. STUDT, D.C., P.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	TS005329	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	950B910390	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1689660326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY D. STUDT, D.C., P.C.

Provider Business Mailing Address
First Line	:	1883 W MONROE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MI
Zip	:	48880-9789
Country	:	US
Telephone Number	:	989-681-2533
Fax Number	:	989-681-2533

Provider Business Practice Location Address
First Line	:	1883 W MONROE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MI
Zip	:	48880-9789
Country	:	US
Telephone Number	:	989-681-2533
Fax Number	:	989-681-2533

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY D. STUDT
Credential	:	DC
Telephone Number	:	989-681-2533

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	10/01/2012

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