Provider Demographics
NPI:1629116462
Name:KAO, TIFFANY MING (DC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MING
Last Name:KAO
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 1:4579 180TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-8747
Mailing Address - Country:US
Mailing Address - Phone:815-273-5022
Mailing Address - Fax:815-273-5023
Practice Address - Street 1:202 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAVANNA
Practice Address - State:IL
Practice Address - Zip Code:61074-1628
Practice Address - Country:US
Practice Address - Phone:815-273-5022
Practice Address - Fax:815-273-5023
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor