Provider Demographics
NPI:1083650337
Name:WEST, TIMOTHY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:WEST
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:PO BOX 4434
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4434
Mailing Address - Country:US
Mailing Address - Phone:423-569-2225
Mailing Address - Fax:423-569-2226
Practice Address - Street 1:18895 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6000
Practice Address - Country:US
Practice Address - Phone:423-569-2225
Practice Address - Fax:423-569-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4870111N00000X
NC1966111N00000X
TNDC-001057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85620037Medicaid
U42648Medicare UPIN
TN3676751Medicare ID - Type Unspecified