Provider Demographics
NPI:1053134981
Name:TILTON, BRIANNA NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:NICOLE
Last Name:TILTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7385 30TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8570
Mailing Address - Country:US
Mailing Address - Phone:616-540-0900
Mailing Address - Fax:
Practice Address - Street 1:1593 GALBRAITH AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-9032
Practice Address - Country:US
Practice Address - Phone:616-949-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23101401581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor