Provider Demographics
NPI:1821405838
Name:POTERBIN, TIFFANY (DC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:POTERBIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:SWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13404A HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1446
Mailing Address - Country:US
Mailing Address - Phone:816-509-5009
Mailing Address - Fax:
Practice Address - Street 1:13404A HOLMES RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1446
Practice Address - Country:US
Practice Address - Phone:816-382-5586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012032774111N00000X
KS01-05620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor