Provider Demographics
NPI:1376504787
Name:NEWCASTLE, TIFFANY N (DC)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:N
Last Name:NEWCASTLE
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 1:3807 WESTLAKE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:IL
Mailing Address - Zip Code:61088-8023
Mailing Address - Country:US
Mailing Address - Phone:815-335-7472
Mailing Address - Fax:
Practice Address - Street 1:427 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECATONICA
Practice Address - State:IL
Practice Address - Zip Code:61063
Practice Address - Country:US
Practice Address - Phone:815-239-1121
Practice Address - Fax:815-239-2766
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL702040Medicare ID - Type Unspecified
ILU90282Medicare UPIN