Provider Demographics
NPI:1992959126
Name:SALA, TIMOTHY PETER (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PETER
Last Name:SALA
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 1:604 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1778
Mailing Address - Country:US
Mailing Address - Phone:989-672-1095
Mailing Address - Fax:989-672-1098
Practice Address - Street 1:765 N STATE ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1545
Practice Address - Country:US
Practice Address - Phone:989-673-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor