Healthcare Provider Details

I. General information

NPI: 1558568956
Provider Name (Legal Business Name): TIFFANY D MURRISH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 N AVENUE F
DENVER CITY TX
79323-2741
US

IV. Provider business mailing address

PO BOX 1415
LOVINGTON NM
88260-1415
US

V. Phone/Fax

Practice location:
  • Phone: 806-752-0055
  • Fax: 575-739-2225
Mailing address:
  • Phone: 806-752-0055
  • Fax: 575-739-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9244
License Number StateTX

VIII. Authorized Official

Name: MRS. KATHLEEN TAYLOR
Title or Position: BUSINESS MANAGER
Credential:
Phone: 806-752-0055