Provider Demographics
NPI:1174371017
Name:TILLMAN FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:TILLMAN FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-419-9191
Mailing Address - Street 1:13295 BUSINESS 331
Mailing Address - Street 2:SUITE A300
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439
Mailing Address - Country:US
Mailing Address - Phone:850-270-1709
Mailing Address - Fax:
Practice Address - Street 1:13295 BUSINESS 331
Practice Address - Street 2:SUITE A300
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439
Practice Address - Country:US
Practice Address - Phone:850-270-1709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty