Provider Demographics
NPI:1134338486
Name:TILLOTSON, TIFFANY ELLENE (DC)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ELLENE
Last Name:TILLOTSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:ELLENE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7923 STEILACOOM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-6150
Mailing Address - Country:US
Mailing Address - Phone:253-584-2414
Mailing Address - Fax:
Practice Address - Street 1:7923 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-6150
Practice Address - Country:US
Practice Address - Phone:253-584-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor