Provider Demographics
NPI:1386670487
Name:PRATT, TIFFANY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MARIE
Last Name:PRATT
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 1:3213 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3763
Mailing Address - Country:US
Mailing Address - Phone:337-406-1988
Mailing Address - Fax:337-406-1908
Practice Address - Street 1:3213 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3763
Practice Address - Country:US
Practice Address - Phone:337-406-1988
Practice Address - Fax:337-406-1908
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1433144Medicaid
LA1433144Medicaid
LAU74978Medicare UPIN