Provider Demographics
NPI:1710328547
Name:PADDEN, TIFFANY RAE (DC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RAE
Last Name:PADDEN
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:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48850-0649
Mailing Address - Country:US
Mailing Address - Phone:989-352-8283
Mailing Address - Fax:989-352-5723
Practice Address - Street 1:960 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-9178
Practice Address - Country:US
Practice Address - Phone:989-352-8283
Practice Address - Fax:989-352-5723
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor