Provider Demographics
NPI:1316925175
Name:BELANGER, TIMOTHY ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:BELANGER
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 1:969 DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-2903
Mailing Address - Country:US
Mailing Address - Phone:413-499-2419
Mailing Address - Fax:413-499-2496
Practice Address - Street 1:969 DALTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-2903
Practice Address - Country:US
Practice Address - Phone:413-499-2419
Practice Address - Fax:413-499-2496
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36104Medicare PIN