Basic Information
| Provider Information | |||||||||
| NPI: | 1376525873 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TIMOTHY J REDD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3475 | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814023475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702408822 | ||||||||
| FaxNumber: | 9702408823 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702408822 | ||||||||
| FaxNumber: | 9702408823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 02/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | JENKINS | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9702408822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 3915 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.