Provider Demographics
NPI:1386880912
Name:DANIELS, TIFFANY MACK (DC)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MACK
Last Name:DANIELS
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 1:2121 RICHMOND RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1206
Mailing Address - Country:US
Mailing Address - Phone:859-272-0002
Mailing Address - Fax:859-264-0916
Practice Address - Street 1:2121 RICHMOND RD
Practice Address - Street 2:SUITE 115
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1206
Practice Address - Country:US
Practice Address - Phone:859-272-0002
Practice Address - Fax:859-264-0916
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-03
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100074310Medicaid
KY7100074310Medicaid