Provider Demographics
NPI:1083827331
Name:LANGHOLDT, TIFFANY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:LANGHOLDT
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 1:1100 N HICKORY BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-7072
Mailing Address - Country:US
Mailing Address - Phone:515-262-2628
Mailing Address - Fax:
Practice Address - Street 1:1100 N HICKORY BLVD
Practice Address - Street 2:STE 201
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-7072
Practice Address - Country:US
Practice Address - Phone:515-262-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06967111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor