Provider Demographics
NPI:1376504837
Name:HOLMES, TIMOTHY DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DEAN
Last Name:HOLMES
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 1:11511 CANTERWOOD BLVD NW
Mailing Address - Street 2:SIOTE 210
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5813
Mailing Address - Country:US
Mailing Address - Phone:253-858-5152
Mailing Address - Fax:253-858-5153
Practice Address - Street 1:11511 CANTERWOOD BLVD NW
Practice Address - Street 2:SIOTE 210
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5813
Practice Address - Country:US
Practice Address - Phone:253-858-5152
Practice Address - Fax:253-858-5153
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 2999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU51323Medicare UPIN
WAG8854861Medicare PIN