MEDICARE: DR. TIMOTHY DEAN HOLMES DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH 2999	WA

General Provider Information

NPI Number	:	1376504837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY DEAN HOLMES DC

Provider Business Mailing Address
First Line	:	11511 CANTERWOOD BLVD NW
Second Line	:	SIOTE 210
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-5813
Country	:	US
Telephone Number	:	253-858-5152
Fax Number	:	253-858-5153

Provider Business Practice Location Address
First Line	:	11511 CANTERWOOD BLVD NW
Second Line	:	SIOTE 210
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-5813
Country	:	US
Telephone Number	:	253-858-5152
Fax Number	:	253-858-5153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	08/13/2012

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