Provider Demographics
NPI:1063765840
Name:AKITA, TIMOTHY (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:AKITA
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 1:3851 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4803
Mailing Address - Country:US
Mailing Address - Phone:503-463-6131
Mailing Address - Fax:503-463-6138
Practice Address - Street 1:3851 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4803
Practice Address - Country:US
Practice Address - Phone:503-463-6131
Practice Address - Fax:503-463-6138
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor