Provider Demographics
NPI:1467065086
Name:RAITH, TIFFANY (DC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:RAITH
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 1:12561 PALM DR STE E
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-4521
Mailing Address - Country:US
Mailing Address - Phone:760-318-5355
Mailing Address - Fax:
Practice Address - Street 1:12561 PALM DR STE E
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-4521
Practice Address - Country:US
Practice Address - Phone:760-318-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor