Provider Demographics
NPI:1487808069
Name:CARLS, TIMOTHY JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:CARLS
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 1:952 VASSAR DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-4436
Mailing Address - Country:US
Mailing Address - Phone:269-344-7946
Mailing Address - Fax:269-344-6196
Practice Address - Street 1:952 VASSAR DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4436
Practice Address - Country:US
Practice Address - Phone:269-344-7946
Practice Address - Fax:269-344-6196
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor