Provider Demographics
NPI:1922370469
Name:TIMMS, BRIAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:TIMMS
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 1:5707 NE 62ND CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1582
Mailing Address - Country:US
Mailing Address - Phone:360-560-3131
Mailing Address - Fax:
Practice Address - Street 1:1412 NE 134TH ST STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685
Practice Address - Country:US
Practice Address - Phone:360-574-6594
Practice Address - Fax:360-574-2235
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60143913225700000X
WACH60822653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist