Provider Demographics
NPI:1841623261
Name:TIBURZI, MICHELLE RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENEE
Last Name:TIBURZI
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 1:1300 GARNET RD
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-4087
Mailing Address - Country:US
Mailing Address - Phone:217-854-8001
Mailing Address - Fax:
Practice Address - Street 1:130 CARLINVILLE PLZ
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1191
Practice Address - Country:US
Practice Address - Phone:217-854-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor