Provider Demographics
NPI:1285189688
Name:LOC, TIFFANY WAI (DC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:WAI
Last Name:LOC
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 1:1951 SW PALM CITY RD
Mailing Address - Street 2:UNIT 26-I
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4296
Mailing Address - Country:US
Mailing Address - Phone:215-584-3828
Mailing Address - Fax:
Practice Address - Street 1:3662 SW 30TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3720
Practice Address - Country:US
Practice Address - Phone:772-220-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor