Provider Demographics
NPI:1306138508
Name:HUNTINGTON PHYSICAL MEDICINE, PLLC
Entity type:Organization
Organization Name:HUNTINGTON PHYSICAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DOREY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:434-249-6333
Mailing Address - Street 1:949 3RD AVE
Mailing Address - Street 2:OFFICE #1C
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1451
Mailing Address - Country:US
Mailing Address - Phone:434-249-6333
Mailing Address - Fax:
Practice Address - Street 1:949 3RD AVE
Practice Address - Street 2:OFFICE #1C
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1451
Practice Address - Country:US
Practice Address - Phone:434-249-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV898111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty