Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3243 | WI |
N | 111NS0005X | Chiropractic Sports Physician | 3243 | WI |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 3243 | WI |
NPI | 1619976263 |
---|---|
Provider Name | Dr. Timothy Lawrence Smykal |
First Address | Menomonee Falls, WI 53051-7100 |
Second Address | Menomonee Falls, WI 53051-7100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2005 |
Last Update Date | 23/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38888200 | (05) | WI |
U43549 | (02) |