Provider Demographics
NPI:1477677136
Name:KRESS, TIMOTHY E (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:KRESS
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 736
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-0736
Mailing Address - Country:US
Mailing Address - Phone:360-466-4050
Mailing Address - Fax:360-466-4050
Practice Address - Street 1:516 MORRIS ST.
Practice Address - Street 2:
Practice Address - City:LACONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-0736
Practice Address - Country:US
Practice Address - Phone:360-466-4050
Practice Address - Fax:360-466-4050
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor