Individual
DR. TIMOTHY DAVID DEROOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
340 SUNSET DR NW, CLEVELAND, TN 37312-5349
(426) 614-5654
(423) 614-5645
Mailing address
340 SUNSET DR NW, CLEVELAND, TN 37312-5349
(426) 614-5654
(423) 614-5645
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC1294
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3043835
BCBS PROVIDER ID NUMBER
TN
05
—
3730366
—
TN
Enumeration date
03/06/2007
Last updated
07/09/2007
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