Provider Demographics
NPI:1528199387
Name:TIFANY A. BURCKHARD-TEETS, DC-P.C.
Entity Type:Organization
Organization Name:TIFANY A. BURCKHARD-TEETS, DC-P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURCKHARD-TEETS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-838-5000
Mailing Address - Street 1:1825 16TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6428
Mailing Address - Country:US
Mailing Address - Phone:701-838-5000
Mailing Address - Fax:701-852-1184
Practice Address - Street 1:1825 16TH ST SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6428
Practice Address - Country:US
Practice Address - Phone:701-838-5000
Practice Address - Fax:701-852-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND02089001OtherBLUE CROSS BLUE SHIELD
ND02089001OtherBLUE CROSS BLUE SHIELD
NDN19970Medicare ID - Type Unspecified