Healthcare Provider Details

I. General information

NPI: 1437233038
Provider Name (Legal Business Name): TIMOTHY GERARD FLYNN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 W JAMES ST SUITE 101
KENT WA
98032-4606
US

IV. Provider business mailing address

1042 W JAMES ST SUITE 101
KENT WA
98032-4606
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-3770
  • Fax: 253-852-3913
Mailing address:
  • Phone: 253-852-3770
  • Fax: 253-852-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: