Provider Demographics
NPI:1376697102
Name:VAAGENES, TIMOTHY JON SR (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JON
Last Name:VAAGENES
Suffix:SR
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 1:2508 HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:BRAHAM
Mailing Address - State:MN
Mailing Address - Zip Code:55006-3759
Mailing Address - Country:US
Mailing Address - Phone:320-396-5068
Mailing Address - Fax:
Practice Address - Street 1:200 VILLAGE CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-7090
Practice Address - Country:US
Practice Address - Phone:651-415-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C231VAOtherBLUE CROSS BLUE SHIELD
MN3C231VAOtherBLUE CROSS BLUE SHIELD