Provider Demographics
NPI:1437233038
Name:FLYNN, TIMOTHY GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GERARD
Last Name:FLYNN
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 1:1042 W JAMES ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4606
Mailing Address - Country:US
Mailing Address - Phone:253-852-3770
Mailing Address - Fax:253-852-3913
Practice Address - Street 1:1042 W JAMES ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4606
Practice Address - Country:US
Practice Address - Phone:253-852-3770
Practice Address - Fax:253-852-3913
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA99750OtherLABOR & INDUSTRY
WA8925702OtherCVCP #
WAFL9444OtherRYDER #
WAFL9444OtherRYDER #