Provider Demographics
NPI:1871737882
Name:TSIOTSIAS, TIM GUS (DC)
Entity type:Individual
Prefix:DR
First Name:TIM
Middle Name:GUS
Last Name:TSIOTSIAS
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 1:2030 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6930
Mailing Address - Country:US
Mailing Address - Phone:954-505-7743
Mailing Address - Fax:954-505-7744
Practice Address - Street 1:2030 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6930
Practice Address - Country:US
Practice Address - Phone:954-925-7333
Practice Address - Fax:954-925-7339
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22173Medicare PIN