Provider Demographics
NPI:1699570317
Name:JIMENEZ, OMAR (DC)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 TACOMA MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7149
Mailing Address - Country:US
Mailing Address - Phone:253-473-0300
Mailing Address - Fax:253-473-0305
Practice Address - Street 1:4902 TACOMA MALL BLVD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7149
Practice Address - Country:US
Practice Address - Phone:253-473-0300
Practice Address - Fax:253-473-0305
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61635539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor