Provider Demographics
NPI:1861525024
Name:CARUTHERS, TIMOTHY LEO (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEO
Last Name:CARUTHERS
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 1:8726 LAKE MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2701
Mailing Address - Country:US
Mailing Address - Phone:619-464-2225
Mailing Address - Fax:619-464-2615
Practice Address - Street 1:8726 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2701
Practice Address - Country:US
Practice Address - Phone:619-464-2225
Practice Address - Fax:619-464-2615
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC01588400OtherBLUE CROSS
CAT82615Medicare UPIN
CADC15884Medicare ID - Type Unspecified