Provider Demographics
NPI:1437554391
Name:LE, TIFFANY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:LE
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 1:9420 BALM RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5116
Mailing Address - Country:US
Mailing Address - Phone:813-672-1818
Mailing Address - Fax:813-642-7145
Practice Address - Street 1:9420 BALM RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569
Practice Address - Country:US
Practice Address - Phone:813-672-1818
Practice Address - Fax:813-642-7145
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor