Provider Demographics
NPI:1437482809
Name:DICKMAN, TIFFANY A (DC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:A
Last Name:DICKMAN
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 1:112 PEHLE AVE
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5230
Mailing Address - Country:US
Mailing Address - Phone:201-961-4712
Mailing Address - Fax:
Practice Address - Street 1:106 W PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1336
Practice Address - Country:US
Practice Address - Phone:201-820-1441
Practice Address - Fax:201-820-1442
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00581500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor