Provider Demographics
NPI:1659439792
Name:TIFERET FAMILY CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:TIFERET FAMILY CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HEROLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-554-6869
Mailing Address - Street 1:5439 DURAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5058
Mailing Address - Country:US
Mailing Address - Phone:262-554-6869
Mailing Address - Fax:262-554-6883
Practice Address - Street 1:5439 DURAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5058
Practice Address - Country:US
Practice Address - Phone:262-554-6869
Practice Address - Fax:262-554-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3954-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38999200Medicaid