Provider Demographics
NPI:1912936220
Name:CHRISTENSEN, TIFFANY J (DC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:J
Last Name:CHRISTENSEN
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 1:960 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1495
Mailing Address - Country:US
Mailing Address - Phone:712-225-2838
Mailing Address - Fax:
Practice Address - Street 1:960 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1495
Practice Address - Country:US
Practice Address - Phone:712-225-2838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0282756Medicaid
IAI8961Medicare ID - Type Unspecified