Healthcare Provider Details

I. General information

NPI: 1376697102
Provider Name (Legal Business Name): TIMOTHY JON VAAGENES SR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VILLAGE CENTER DR SUITE 100
NORTH OAKS MN
55127-7090
US

IV. Provider business mailing address

2508 HIGHWAY 70
BRAHAM MN
55006-3759
US

V. Phone/Fax

Practice location:
  • Phone: 651-415-0446
  • Fax:
Mailing address:
  • Phone: 320-396-5068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3144
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: