Provider Demographics
NPI:1881035160
Name:TITHER, ERIC RICHARD (LAC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:RICHARD
Last Name:TITHER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6049
Mailing Address - Country:US
Mailing Address - Phone:406-491-4849
Mailing Address - Fax:406-723-3338
Practice Address - Street 1:2210 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6049
Practice Address - Country:US
Practice Address - Phone:406-491-4849
Practice Address - Fax:406-723-3338
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT177171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist