Provider Demographics
NPI:1285618785
Name:FAULKNER, TIMOTHY (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:FAULKNER
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 1:500 E OGDEN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3213
Mailing Address - Country:US
Mailing Address - Phone:630-355-9771
Mailing Address - Fax:
Practice Address - Street 1:500 E OGDEN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3213
Practice Address - Country:US
Practice Address - Phone:630-355-9771
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL914341Medicare ID - Type Unspecified
ILT90518Medicare UPIN