Provider Demographics
NPI:1548280019
Name:GURROLA, TIMOTHY JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:GURROLA
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 1:1405 E LINCOLNWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-8023
Mailing Address - Country:US
Mailing Address - Phone:219-325-3069
Mailing Address - Fax:219-362-0015
Practice Address - Street 1:1405 E LINCOLNWAY
Practice Address - Street 2:SUITE A
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-8023
Practice Address - Country:US
Practice Address - Phone:219-325-3069
Practice Address - Fax:219-362-0015
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001751A111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN68008Medicare UPIN