Provider Demographics
NPI:1174053250
Name:SCHLANK, TIMOTHY DAVID (DOM)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:SCHLANK
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 CROSBY DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6223
Mailing Address - Country:US
Mailing Address - Phone:219-242-9958
Mailing Address - Fax:
Practice Address - Street 1:9501 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2664
Practice Address - Country:US
Practice Address - Phone:218-595-5529
Practice Address - Fax:219-595-5529
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000190A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty