Provider Demographics
NPI:1861551772
Name:WARREN, TIMOTHY W (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:WARREN
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 1:2797 POST ROAD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-3001
Mailing Address - Country:US
Mailing Address - Phone:401-738-6478
Mailing Address - Fax:401-738-7310
Practice Address - Street 1:2797 POST ROAD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3001
Practice Address - Country:US
Practice Address - Phone:401-738-6478
Practice Address - Fax:401-738-7310
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRIDC265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9119-2OtherBC PROVIDER ID
RI9119-2OtherBC PROVIDER ID
RI359009119Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID