Provider Demographics
NPI:1215295506
Name:DALY, TIMOTHY JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:DALY
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 1:1851 STONE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-2415
Mailing Address - Country:US
Mailing Address - Phone:585-225-6430
Mailing Address - Fax:585-225-9636
Practice Address - Street 1:2364 LYELL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5738
Practice Address - Country:US
Practice Address - Phone:585-429-5100
Practice Address - Fax:585-429-5101
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor