Provider Demographics
NPI:1013252865
Name:JOHNSON, TIFFANY NOEL (DC)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:NOEL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4858
Mailing Address - Country:US
Mailing Address - Phone:573-544-4952
Mailing Address - Fax:
Practice Address - Street 1:1618 W COLORADO AVE STE 6
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-4029
Practice Address - Country:US
Practice Address - Phone:573-544-4952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008089111N00000X
MO2017043621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor