MEDICARE: MR. TIMOTHY ILIFF JR. LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1164808515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY ILIFF JR. LAC

Provider Business Mailing Address
First Line	:	1171 MARKET ST STE 112
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6502
Country	:	US
Telephone Number	:	803-802-7799
Fax Number	:

Provider Business Practice Location Address
First Line	:	1171 MARKET ST STE 112
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6502
Country	:	US
Telephone Number	:	803-802-7799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2015
Last Update Date	:	01/31/2020

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Directions to “ MR. TIMOTHY ILIFF JR. LAC” Practice Location

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