Provider Demographics
NPI:1619659646
Name:AMANDA TIPTON STILLER DC, LLC
Entity Type:Organization
Organization Name:AMANDA TIPTON STILLER DC, LLC
Other - Org Name:CROSSROADS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:CAROLE
Authorized Official - Last Name:TIPTON STILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-303-4637
Mailing Address - Street 1:13500 SW 72ND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8013
Mailing Address - Country:US
Mailing Address - Phone:503-620-1280
Mailing Address - Fax:503-620-6062
Practice Address - Street 1:13500 SW 72ND AVE STE 105
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8013
Practice Address - Country:US
Practice Address - Phone:503-620-1280
Practice Address - Fax:503-620-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty