Provider Demographics
NPI:1144308578
Name:BELLEAU, TIMOTHY JAMES (BS DC CCSP CKTP)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:BELLEAU
Suffix:
Gender:M
Credentials:BS DC CCSP CKTP
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Mailing Address - Street 1:825 S HURON RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8049
Mailing Address - Country:US
Mailing Address - Phone:920-406-8700
Mailing Address - Fax:920-406-8712
Practice Address - Street 1:825 S HURON RD
Practice Address - Street 2:SUITE H
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-8049
Practice Address - Country:US
Practice Address - Phone:920-406-8700
Practice Address - Fax:920-406-8712
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2015-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI2670012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38868000Medicaid
WI38868000Medicaid