Provider Demographics
NPI:1902897242
Name:DESCHENES, TIMOTHY E (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
Last Name:DESCHENES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:3631 MAIN STREET
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484-0514
Mailing Address - Country:US
Mailing Address - Phone:845-687-0088
Mailing Address - Fax:845-687-0089
Practice Address - Street 1:BOX 514
Practice Address - Street 2:3631 MAIN STREET
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484
Practice Address - Country:US
Practice Address - Phone:845-687-0088
Practice Address - Fax:845-687-0089
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U65451Medicare UPIN
NYX87611Medicare ID - Type Unspecified