Provider Demographics
NPI:1700890191
Name:HERBERT, TIFFANY SHAWN (D C)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:SHAWN
Last Name:HERBERT
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 PARKLAWN DR STE 10
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4213
Mailing Address - Country:US
Mailing Address - Phone:405-455-3799
Mailing Address - Fax:405-455-3798
Practice Address - Street 1:2828 PARKLAWN DR STE 10
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4213
Practice Address - Country:US
Practice Address - Phone:405-455-3799
Practice Address - Fax:405-455-3798
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU99192Medicare UPIN