Provider Demographics
NPI:1962798058
Name:HOTZ, TIMOTHY MARK (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MARK
Last Name:HOTZ
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 1:1820 DILLON AVE
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4252
Mailing Address - Country:US
Mailing Address - Phone:307-426-4085
Mailing Address - Fax:
Practice Address - Street 1:1820 DILLON AVE
Practice Address - Street 2:SUITE 200B
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4252
Practice Address - Country:US
Practice Address - Phone:307-426-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW24226OtherPTAN
WYW24227OtherMEDICARE PTAN