Provider Demographics
NPI:1275523474
Name:JONES-LEE, TIFFANY DAWN (DC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DAWN
Last Name:JONES-LEE
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 1:312 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-2914
Mailing Address - Country:US
Mailing Address - Phone:936-327-8800
Mailing Address - Fax:936-327-3049
Practice Address - Street 1:312 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-2914
Practice Address - Country:US
Practice Address - Phone:936-327-8800
Practice Address - Fax:936-327-3049
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609137Medicaid
TX04-3775246OtherTAX ID #
TX609137Medicare PIN
TXU72173Medicare UPIN