Provider Demographics
NPI:1194757203
Name:TINIUS, BRIAN W (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:TINIUS
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 1:1300 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6965
Mailing Address - Country:US
Mailing Address - Phone:270-926-8042
Mailing Address - Fax:270-926-8099
Practice Address - Street 1:1300 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6965
Practice Address - Country:US
Practice Address - Phone:270-926-8042
Practice Address - Fax:270-926-8099
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002657Medicaid
KY000000339844OtherANTHEM
00400002Medicare PIN