Provider Demographics
NPI:1063796738
Name:PLUMLEY, TIMOTHY M (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:PLUMLEY
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 1:6006 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3607
Mailing Address - Country:US
Mailing Address - Phone:314-352-1343
Mailing Address - Fax:314-352-1368
Practice Address - Street 1:6006 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3607
Practice Address - Country:US
Practice Address - Phone:314-352-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011032371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor