Basic Information
| Provider Information | |||||||||
| NPI: | 1043366347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KISTLER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 GRANITE ST | ||||||||
| Address2: | STE 3 | ||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021845350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178262273 | ||||||||
| FaxNumber: | 3178262673 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 WILLARD ST STE 2A | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021691274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178047464 | ||||||||
| FaxNumber: | 6174711114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2007 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | 08001237 | IN | N | Chiropractic Providers | Chiropractor | Sports Physician | 111N00000X | 3594 | MA | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | P00006924 | 01 | IN | RAILROAD MEDICARE | OTHER | 000000344943 | 01 | IN | BCBS | OTHER | 200077400A | 05 | IN | MEDICAID | AETNA | 01 | IN | 4351909 | OTHER | 6904776002 | 01 | IN | CIGNA | OTHER |