Provider Demographics
NPI:1710268271
Name:CHRISTIE, TIFFANY CHERIE (DC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:CHERIE
Last Name:CHRISTIE
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 1:628 PEREGRINE DR
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4774
Mailing Address - Country:US
Mailing Address - Phone:321-544-6772
Mailing Address - Fax:
Practice Address - Street 1:1501 AVOCADO AVE STE 1
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6593
Practice Address - Country:US
Practice Address - Phone:321-339-8876
Practice Address - Fax:321-541-9114
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor