Provider Demographics
NPI:1154362952
Name:TREANOR, TIM DENNIS (DC)
Entity type:Individual
Prefix:DR
First Name:TIM
Middle Name:DENNIS
Last Name:TREANOR
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 1:4161 CAPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3128
Mailing Address - Country:US
Mailing Address - Phone:252-903-3103
Mailing Address - Fax:252-210-3489
Practice Address - Street 1:4161 CAPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3128
Practice Address - Country:US
Practice Address - Phone:252-903-3103
Practice Address - Fax:252-210-3489
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1154362952Medicaid
NC0828YOtherBCBS
NC1154362952OtherCNC/MC/MD
NC890828YMedicaid
NC890828YMedicaid