Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 11723 | TX |
N | 111NP0017X | Pediatric Chiropractor | 11723 | TX |
NPI | 1659976074 |
---|---|
Provider Name | Dr. Tiffany Marie Poole |
First Address | Cypress, TX 77433-5003 |
Second Address | Katy, TX 77494-6058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2020 |
Last Update Date | 02/12/2020 |