Provider Demographics
NPI:1851783732
Name:TIMM, JOHN EDWAD JR (EAMP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWAD
Last Name:TIMM
Suffix:JR
Gender:M
Credentials:EAMP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1419 W MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9830
Mailing Address - Country:US
Mailing Address - Phone:360-624-1106
Mailing Address - Fax:
Practice Address - Street 1:602 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-8145
Practice Address - Country:US
Practice Address - Phone:360-624-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60539781171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist