Provider Demographics
NPI:1801015722
Name:WARREN, TIMOTHY VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:VINCENT
Last Name:WARREN
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 1:105 112TH ST S # 178
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98444-5711
Mailing Address - Country:US
Mailing Address - Phone:253-876-4256
Mailing Address - Fax:253-295-6418
Practice Address - Street 1:10625 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-6065
Practice Address - Country:US
Practice Address - Phone:253-876-4256
Practice Address - Fax:253-295-6418
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor