Provider Demographics
NPI:1245532944
Name:RUSSELL, TIFFANY MILAN (DC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MILAN
Last Name:RUSSELL
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 1:12080 SKYHAWK DR
Mailing Address - Street 2:UNIT B
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-8305
Mailing Address - Country:US
Mailing Address - Phone:717-749-7111
Mailing Address - Fax:717-749-7113
Practice Address - Street 1:12080 SKYHAWK DR
Practice Address - Street 2:UNIT B
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-8305
Practice Address - Country:US
Practice Address - Phone:717-749-7111
Practice Address - Fax:717-749-7113
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor