Provider Demographics
NPI:1982762407
Name:BURCKHARD-TEETS, TIFANY A (DC)
Entity Type:Individual
Prefix:DR
First Name:TIFANY
Middle Name:A
Last Name:BURCKHARD-TEETS
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 1:1825 16TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6428
Mailing Address - Country:US
Mailing Address - Phone:701-838-5000
Mailing Address - Fax:701-852-1184
Practice Address - Street 1:1825 16TH ST SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6428
Practice Address - Country:US
Practice Address - Phone:701-838-5000
Practice Address - Fax:701-852-1184
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19970OtherBLUE CROSS BLUE SHIELD
NDU82802Medicare UPIN
ND19970OtherBLUE CROSS BLUE SHIELD