MEDICARE: DR. TIFFANY STIEBEL BUTLER D.C.

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	111N00000X	Chiropractor	3367	SC

General Provider Information

NPI Number	:	1700048949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY STIEBEL BUTLER D.C.

Provider Business Mailing Address
First Line	:	1151 ROBERT GRISSOM PKWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5664
Country	:	US
Telephone Number	:	843-839-5588
Fax Number	:	843-839-5591

Provider Business Practice Location Address
First Line	:	1151 ROBERT GRISSOM PKWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5664
Country	:	US
Telephone Number	:	843-839-5588
Fax Number	:	843-839-5591

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

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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