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NPI Code Detail

MEDICARE: DR. TIFFANI TABISH FRIES D.C.

MEDICARE: DR. TIFFANI TABISH FRIES 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
1111N00000XChiropractor5005891-1202UT

General Provider Information

NPI Number : 1114977105
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIFFANI TABISH FRIES D.C.
Provider Business Mailing Address
First Line : 1200 E 3300 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-2522
Country : US
Telephone Number : 801-485-2580
Fax Number : 801-485-2587
Provider Business Practice Location Address
First Line : 1200 E 3300 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-2522
Country : US
Telephone Number : 801-485-2580
Fax Number : 801-485-2587
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 04/05/2012

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