MEDICARE: TIMOTHY MARCHANT COCKER 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	23772	CA

General Provider Information

NPI Number	:	1972537447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY MARCHANT COCKER D.C.

Provider Business Mailing Address
First Line	:	7816 UPLANDS WAY
Second Line	:	SUITE A
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7567
Country	:	US
Telephone Number	:	916-967-5088
Fax Number	:	916-967-5089

Provider Business Practice Location Address
First Line	:	7816 UPLANDS WAY
Second Line	:	SUITE A
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7567
Country	:	US
Telephone Number	:	916-967-5088
Fax Number	:	916-967-5089

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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