Provider Demographics
NPI:1801669171
Name:PINCOCK, TYRELL (DC)
Entity type:Individual
Prefix:
First Name:TYRELL
Middle Name:
Last Name:PINCOCK
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 N PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9129
Mailing Address - Country:US
Mailing Address - Phone:360-666-6001
Mailing Address - Fax:
Practice Address - Street 1:105 N PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9129
Practice Address - Country:US
Practice Address - Phone:360-637-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61493624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor