Provider Demographics
NPI:1083719108
Name:LABRECQUE, TIFFANY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:LABRECQUE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7948 DAVIS BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-1903
Mailing Address - Country:US
Mailing Address - Phone:817-577-6061
Mailing Address - Fax:817-577-2345
Practice Address - Street 1:7948 DAVIS BLVD # 200
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-1903
Practice Address - Country:US
Practice Address - Phone:817-577-6061
Practice Address - Fax:817-577-2345
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00196TMedicare ID - Type UnspecifiedGROUP #
TX8A0166Medicare UPIN