Provider Demographics
NPI:1992760433
Name:TIMBERLAKE, BILL W (DC)
Entity type:Individual
Prefix:DR
First Name:BILL
Middle Name:W
Last Name:TIMBERLAKE
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 1:3016 N JIM MILLER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-6026
Mailing Address - Country:US
Mailing Address - Phone:214-381-1481
Mailing Address - Fax:214-381-6795
Practice Address - Street 1:3016 N JIM MILLER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-6026
Practice Address - Country:US
Practice Address - Phone:214-381-1481
Practice Address - Fax:214-381-6795
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT16296Medicare UPIN
TX600214Medicare ID - Type Unspecified