Provider Demographics
NPI:1245776442
Name:MOLLER, TIMOTHY (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MOLLER
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 1:120 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-1235
Mailing Address - Country:US
Mailing Address - Phone:631-741-8321
Mailing Address - Fax:
Practice Address - Street 1:2995 BASELINE RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303
Practice Address - Country:US
Practice Address - Phone:303-444-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007718111N00000X
CT7.002053111NS0005X
NJ38MC00741000111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Yes111N00000XChiropractic ProvidersChiropractor