Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 086250 | IA |
Y | 111NR0400X | Rehabilitation Chiropractor | 14712 | TX |
NPI | 1063953693 |
---|---|
Provider Name | Tiffany Themas |
First Address | Lubbock, TX 79423-1122 |
Second Address | Lubbock, TX 79423-1122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2017 |
Last Update Date | 06/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063953693 | (05) | IA |