| Doctor Name: | DR. TIM PAUL SHANNON |
| NPI Number: | 1023263027 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | N.D. |
| License Number: | NT60332027 |
| Business Practice Address: | 205 Clark Pl Se Tumwater, WA - 985014062 |
| Business Phone Number: | 3605700401 |
| Business Fax Number: | 3605702060 |
| Mailing Address: | 205 Clark Pl Se, TUMWATER |
| State: | WA |
| Postal Code: | 985014062 |
| Phone Number: | 3605700401 |
| Fax Number: | 3605702060 |
| NPI Enumeration Date: | 11/19/2008 |
| NPI Last Update Date: | 03/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | NT60332027 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |