Provider Demographics
NPI:1245503283
Name:WARNER, TIMOTHY RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RYAN
Last Name:WARNER
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 1:2124 BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4914
Mailing Address - Country:US
Mailing Address - Phone:732-892-5775
Mailing Address - Fax:732-892-5727
Practice Address - Street 1:2124 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-4914
Practice Address - Country:US
Practice Address - Phone:732-892-5775
Practice Address - Fax:732-892-5727
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00697300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor