Basic Information
| Provider Information | |||||||||
| NPI: | 1174516231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLANTON | ||||||||
| FirstName: | TIM | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13030 121ST WAY NE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980347210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258142800 | ||||||||
| FaxNumber: | 4258230882 | ||||||||
| Practice Location | |||||||||
| Address1: | 13030 121ST WAY NE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980347210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258142800 | ||||||||
| FaxNumber: | 4258230882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 02/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH00034011 | WA | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 4011CL | 01 | REGENCE BLUE SHIELD | OTHER | 192264900 | 01 | FEDERAL WORKER'S COMP | OTHER | 8423345 | 05 | WA | MEDICAID | 0189969 | 01 | WA | LABOR & INDUSTRIES | OTHER |