Provider Demographics
NPI:1710523261
Name:MCCLURE, TIFFANY LEANNE (DC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEANNE
Last Name:MCCLURE
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 1:409 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-5623
Mailing Address - Country:US
Mailing Address - Phone:910-608-2224
Mailing Address - Fax:910-608-2055
Practice Address - Street 1:409 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-5623
Practice Address - Country:US
Practice Address - Phone:910-608-2224
Practice Address - Fax:910-608-2055
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor