Provider Demographics
NPI:1700196235
Name:TIFFANY CHRISTENSEN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:TIFFANY CHRISTENSEN CHIROPRACTIC PC
Other - Org Name:RIVERVIEW CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-225-2838
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-2202
Mailing Address - Country:US
Mailing Address - Phone:712-225-2838
Mailing Address - Fax:712-225-6087
Practice Address - Street 1:515 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1786
Practice Address - Country:US
Practice Address - Phone:712-225-2838
Practice Address - Fax:712-225-6087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0282756Medicaid