Provider Demographics
NPI:1720578263
Name:DR. TIFFANY A DICKMAN, D.C, LLC
Entity Type:Organization
Organization Name:DR. TIFFANY A DICKMAN, D.C, LLC
Other - Org Name:TIFFANY A DICKMAN, D.C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-961-4712
Mailing Address - Street 1:160 MARKET STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663
Mailing Address - Country:US
Mailing Address - Phone:201-250-8810
Mailing Address - Fax:201-712-1444
Practice Address - Street 1:160 MARKET STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663
Practice Address - Country:US
Practice Address - Phone:201-250-8810
Practice Address - Fax:201-712-1444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR TIFFANY A DICKMAN, DC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00581500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty