Provider Demographics
NPI:1063953693
Name:THEMAS, TIFFANY (DC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:THEMAS
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 DAVENSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2602
Mailing Address - Country:US
Mailing Address - Phone:563-212-3461
Mailing Address - Fax:
Practice Address - Street 1:1820 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3204
Practice Address - Country:US
Practice Address - Phone:563-940-3096
Practice Address - Fax:806-305-0002
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14712111NR0400X
IA086250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1063953693Medicaid