Provider Demographics
NPI:1770769069
Name:BREY, TIFFANY MARIE (DC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:BREY
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 1:2230 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63780-1329
Mailing Address - Country:US
Mailing Address - Phone:573-264-1999
Mailing Address - Fax:573-264-1998
Practice Address - Street 1:2230 MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:MO
Practice Address - Zip Code:63780-1329
Practice Address - Country:US
Practice Address - Phone:573-264-1999
Practice Address - Fax:573-264-1998
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011090111N00000X
MO2008036327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor