Provider Demographics
NPI:1871552448
Name:VANCLEVE, TIMOTHY RAYMOND (DC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:RAYMOND
Last Name:VANCLEVE
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 1:214 S CITIES SERVICE HWY
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6404
Mailing Address - Country:US
Mailing Address - Phone:337-625-4077
Mailing Address - Fax:337-625-5938
Practice Address - Street 1:214 S CITIES SERVICE HWY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6404
Practice Address - Country:US
Practice Address - Phone:337-625-4077
Practice Address - Fax:337-625-5938
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5167439OtherAETNA
LA5S838Medicare ID - Type Unspecified
LAU29335Medicare UPIN