Provider Demographics
NPI:1245583301
Name:O'DOYLE, TIMOTHY CHETAN
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHETAN
Last Name:O'DOYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:PATRICK
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2730 172ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-4420
Mailing Address - Country:US
Mailing Address - Phone:360-540-1299
Mailing Address - Fax:
Practice Address - Street 1:2730 172ND ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4420
Practice Address - Country:US
Practice Address - Phone:360-540-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor