Provider Demographics
NPI:1518192558
Name:ALLISON, TIMOTHY R (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:ALLISON
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 1:310 S. CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:PA
Mailing Address - Zip Code:15627
Mailing Address - Country:US
Mailing Address - Phone:724-570-1389
Mailing Address - Fax:724-694-0677
Practice Address - Street 1:310 S. CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:PA
Practice Address - Zip Code:15627
Practice Address - Country:US
Practice Address - Phone:724-570-1389
Practice Address - Fax:724-694-0677
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1815OtherDC LICENSE