Provider Demographics
NPI:1194874099
Name:TILLER, CARREY ANNE (DC)
Entity type:Individual
Prefix:
First Name:CARREY
Middle Name:ANNE
Last Name:TILLER
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 1:11685 BALSAM CT
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-5783
Mailing Address - Country:US
Mailing Address - Phone:251-380-0477
Mailing Address - Fax:
Practice Address - Street 1:205 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-2927
Practice Address - Country:US
Practice Address - Phone:251-380-0477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00194901OtherPALMETTO GBA RAILROAD
AL51001036OtherBCBS
ALP00194901OtherPALMETTO GBA RAILROAD