Provider Demographics
NPI:1124272372
Name:TIMBERLAND CHIROPRACTIC PC
Entity type:Organization
Organization Name:TIMBERLAND CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:TAD
Authorized Official - Last Name:GUILD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-782-3180
Mailing Address - Street 1:PO BOX 895
Mailing Address - Street 2:1050 N HWY 414
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:WY
Mailing Address - Zip Code:82939-0895
Mailing Address - Country:US
Mailing Address - Phone:307-782-3180
Mailing Address - Fax:307-782-3181
Practice Address - Street 1:1050 N HWY 414
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:WY
Practice Address - Zip Code:82939
Practice Address - Country:US
Practice Address - Phone:307-782-3180
Practice Address - Fax:307-782-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty