Provider Demographics
NPI:1871533497
Name:COYKENDALL, TIMOTHY J (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:COYKENDALL
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 1:438 W BEVERLY PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3011
Mailing Address - Country:US
Mailing Address - Phone:209-832-9221
Mailing Address - Fax:209-832-9297
Practice Address - Street 1:438 BEVERLY PL.
Practice Address - Street 2:SUITE101
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376
Practice Address - Country:US
Practice Address - Phone:209-832-9221
Practice Address - Fax:209-832-9297
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0266170Medicare PIN