Provider Demographics
NPI:1396096129
Name:VINCENT, TIMOTHY SHANE (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SHANE
Last Name:VINCENT
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 1:1133 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-1835
Mailing Address - Country:US
Mailing Address - Phone:270-298-0077
Mailing Address - Fax:270-298-0078
Practice Address - Street 1:1133 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1835
Practice Address - Country:US
Practice Address - Phone:270-298-0077
Practice Address - Fax:270-298-0078
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor