Provider Demographics
NPI:1174861884
Name:BURKLEY, TIFFANY (RMT, LMT,)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BURKLEY
Suffix:
Gender:F
Credentials:RMT, LMT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510305
Mailing Address - Street 2:
Mailing Address - City:KEY COLONY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33051-0305
Mailing Address - Country:US
Mailing Address - Phone:954-501-3937
Mailing Address - Fax:
Practice Address - Street 1:2885 AURORA AVE STE E14
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2250
Practice Address - Country:US
Practice Address - Phone:954-501-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor