Provider Demographics
NPI:1780052977
Name:TIPTON STILLER, AMANDA CAROLE (DC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CAROLE
Last Name:TIPTON STILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CAROLE
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:13500 SW 72ND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8013
Mailing Address - Country:US
Mailing Address - Phone:503-620-1280
Mailing Address - Fax:
Practice Address - Street 1:13500 SW 72ND AVE STE 105
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8013
Practice Address - Country:US
Practice Address - Phone:503-620-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor