Provider Demographics
NPI:1740477694
Name:RENN, TIMOTHY G (DC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:G
Last Name:RENN
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 1:10919 CANYON RD E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4262
Mailing Address - Country:US
Mailing Address - Phone:253-539-3854
Mailing Address - Fax:253-539-3864
Practice Address - Street 1:10919 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4262
Practice Address - Country:US
Practice Address - Phone:253-539-3854
Practice Address - Fax:253-539-3864
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor