Provider Demographics
NPI:1164808515
Name:ILIFF, TIMOTHY JR (LAC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:ILIFF
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 MARKET ST STE 112
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6502
Mailing Address - Country:US
Mailing Address - Phone:803-802-7799
Mailing Address - Fax:
Practice Address - Street 1:1171 MARKET ST STE 112
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6502
Practice Address - Country:US
Practice Address - Phone:803-802-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-08
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist