Provider Demographics
NPI:1740474139
Name:TIFFANY HERBERT, D.C.
Entity type:Organization
Organization Name:TIFFANY HERBERT, D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-455-3799
Mailing Address - Street 1:2828 PARKLAWN DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4216
Mailing Address - Country:US
Mailing Address - Phone:405-455-3799
Mailing Address - Fax:405-455-3798
Practice Address - Street 1:2828 PARKLAWN DR
Practice Address - Street 2:SUITE 10
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4216
Practice Address - Country:US
Practice Address - Phone:405-455-3799
Practice Address - Fax:405-455-3798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU99192Medicare UPIN