Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH0004523 | FL |
NPI | 1326174673 |
---|---|
Provider Name | Dr. John Randall Timko |
First Address | Deland, FL 32720-3208 |
Second Address | Deland, FL 32720-3208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 01/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
055613100 | (05) | FL |
T94404 | (02) |