Provider Demographics
NPI:1942980032
Name:BECERRA ALWAZAN, TIFFANI (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANI
Middle Name:
Last Name:BECERRA ALWAZAN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 EAST ROOSEVELT ROAD
Mailing Address - Street 2:NUMBER 195
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:317-999-5136
Mailing Address - Fax:
Practice Address - Street 1:9 N UNION ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5334
Practice Address - Country:US
Practice Address - Phone:312-834-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist