NPIMap

Organization Active NPI

Tiffany Renaud, Inc.

Doing business as Living Well Spinal Care Center

  • Chiropractor
  • South Burlington, VT
National Provider Identifier
1366618118
Registry record updated May 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0060000905 Issued in VT
Legal business name
TIFFANY RENAUD, INC.
Doing business as
Living Well Spinal Care Center
Practice address
3000 Williston Rd
Suite 3
South Burlington, VT 05403-6082
Phone
(802) 658-6092
Fax
(802) 863-9565
NPI assigned
May 1, 2008
Last updated
May 8, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tiffany Renaud, D.C.NPI 1326122623
Title
President
Phone
(802) 658-6092

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 0060000905 VT Primary

Addresses

Primary practice location

3000 Williston Rd
Suite 3
South Burlington, VT 05403-6082

Mailing address

3000 Williston Rd
Suite 3
South Burlington, VT 05403-6082
Phone (802) 658-6092

Other identifiers 2

IdentifierTypeStateIssuer
VN3492OtherVTMEDICARE GROUP ID
TIFF00018436OtherVTBCBS

Other names 1

  • Living Well Spinal Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120418000461 VT Part B Supplier - Clinic/Group Practice 8022279074 Receives reassigned benefits from 2 practitioners
Practice locations: Essex JCT, VT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Living Well Spinal Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3000 Williston Rd
Ste 3
South Burlington, VT 05403
Phone (802) 658-6092

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336435200000",
    "number": "1366618118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 WILLISTON RD",
            "address_2": "SUITE 3",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036082",
            "telephone_number": "802-658-6092",
            "fax_number": "802-863-9565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 WILLISTON RD",
            "address_2": "SUITE 3",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036082",
            "telephone_number": "802-658-6092",
            "fax_number": "802-863-9565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFFANY RENAUD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-01",
        "last_updated": "2012-05-08",
        "status": "A",
        "authorized_official_last_name": "RENAUD",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "802-658-6092",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VT",
            "license": "0060000905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "VN3492",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "TIFF00018436",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Living Well Spinal Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Burlington, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.