Provider Demographics
NPI:1811215163
Name:WEINGARD, TY RICHARD (DC)
Entity type:Individual
Prefix:
First Name:TY
Middle Name:RICHARD
Last Name:WEINGARD
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 1:2900NE132ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-3014
Mailing Address - Country:US
Mailing Address - Phone:503-255-6771
Mailing Address - Fax:503-251-5794
Practice Address - Street 1:22202 121ST ST E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7669
Practice Address - Country:US
Practice Address - Phone:253-691-4260
Practice Address - Fax:253-862-5218
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor