Provider Demographics
NPI:1962449512
Name:WANG, TIMOTHY C (DC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:C
Last Name:WANG
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 1:136 WEST MAIN STREET
Mailing Address - Street 2:SHAW CHIROPRACTIC
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1315
Mailing Address - Country:US
Mailing Address - Phone:860-826-4763
Mailing Address - Fax:860-826-4762
Practice Address - Street 1:36 GRAND STREET
Practice Address - Street 2:SHAW CHIROPRACTIC
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-522-2225
Practice Address - Fax:860-493-2509
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor