Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3594 | MA |
N | 111NS0005X | Chiropractic Sports Physician | 08001237 | IN |
NPI | 1043366347 |
---|---|
Provider Name | Dr. Timothy J Kistler |
First Address | Braintree, MA 02184-5350 |
Second Address | Quincy, MA 02169-1274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2007 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000344943 | BCBS (01) | IN |
200077400A | (05) | IN |
6904776002 | CIGNA (01) | IN |
AETNA | 4351909 (01) | IN |
P00006924 | RAILROAD MEDICARE (01) | IN |
T95583 | (02) | IN |