Provider Demographics
NPI:1679458087
Name:GROTHE, TIMOTHY (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:GROTHE
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 1:1325 TUCKER LN
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-1020
Mailing Address - Country:US
Mailing Address - Phone:713-907-6507
Mailing Address - Fax:
Practice Address - Street 1:209 SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1278
Practice Address - Country:US
Practice Address - Phone:713-907-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13013111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation