Timothy Douglass DC PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH9683 Issued in FL

Legal business name

TIMOTHY DOUGLASS DC PA

Doing business as

Douglass Chiropractic

Practice address

4221 Commons Dr East
Ste B-105
Deston, FL 32541-3483

Phone

(850) 650-6789

Fax

(850) 650-6790

NPI assigned

Mar 18, 2010

Last updated

Nov 3, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Timothy D Douglass, D.C.NPI 1306913884

Title

President

Phone

(850) 650-6789

Specialties & licenses 1

Addresses

Other names 1

• Douglass Chiropractic Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy Deegan Douglass, D.C.

  • Chiropractor
  • Destin, FL
  • NPI 1306913884
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320278400000",
    "number": "1275857385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4421 COMMONS DR E",
            "address_2": "# B-105",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325413484",
            "telephone_number": "850-650-6789",
            "fax_number": "850-650-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4221 COMMONS DR EAST",
            "address_2": "STE B-105",
            "city": "DESTON",
            "state": "FL",
            "postal_code": "325413483",
            "telephone_number": "850-650-6789",
            "fax_number": "850-650-6790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY DOUGLASS DC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-18",
        "last_updated": "2011-11-03",
        "status": "A",
        "authorized_official_last_name": "DOUGLASS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-650-6789",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH9683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Douglass Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.