Provider Demographics
NPI:1174596845
Name:ZOOK, TIMOTHY LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LYNN
Last Name:ZOOK
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 1:1148 JOHN SIMS PKWY E
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2204
Mailing Address - Country:US
Mailing Address - Phone:850-678-4155
Mailing Address - Fax:
Practice Address - Street 1:1148 JOHN SIMS PKWY E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2204
Practice Address - Country:US
Practice Address - Phone:850-678-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380631600Medicaid
FL22646Medicare ID - Type Unspecified
FL380631600Medicaid