Provider Demographics
NPI:1689655458
Name:IRVING, TIMOTHY GENE (DC, LMT)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GENE
Last Name:IRVING
Suffix:
Gender:M
Credentials:DC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 SE MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3017
Mailing Address - Country:US
Mailing Address - Phone:503-866-9739
Mailing Address - Fax:
Practice Address - Street 1:819 SE MORRISON ST STE 215
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-6317
Practice Address - Country:US
Practice Address - Phone:503-866-9739
Practice Address - Fax:503-716-4575
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3622111N00000X
OR10250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No111N00000XChiropractic ProvidersChiropractor