Provider Demographics
NPI:1538175815
Name:O'BRIEN, TIMOTHY WARREN (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WARREN
Last Name:O'BRIEN
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 1:430 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1565
Mailing Address - Country:US
Mailing Address - Phone:606-783-0994
Mailing Address - Fax:606-783-0994
Practice Address - Street 1:547 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1539
Practice Address - Country:US
Practice Address - Phone:606-780-7400
Practice Address - Fax:606-783-0994
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
K036560Medicare PIN