Individual provider Active NPI

Tiffany Logan Jeffries-Fernandez, DC

  • Chiropractor
  • Virginia Beach, VA
National Provider Identifier
1457586133
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
104556510 Issued in VA
Practice address
3074 Brickhouse CT
Virginia Beach, VA 23452-6859
Phone
(757) 227-4100
Fax
(757) 963-9157
NPI assigned
May 24, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 104556510 VA Primary

Addresses

Primary practice location

3074 Brickhouse CT
Virginia Beach, VA 23452-6859

Mailing address

3074 Brickhouse CT
Virginia Beach, VA 23452-6859
Phone (757) 227-4100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111005000353 VA Practitioner - Chiropractic 5395794929 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
104556510VAMDChiropractor
010500NYMDOptician

Practice roles

OrganizationSpecialtyStatusNew patients
Cpe Medical Systems LLC CurrentSince Sep 12, 2016 Accepting new patients
Theradynamics Physical Therapy Rehabilitation PC Past Accepting new patients
Theradynamics Physical Rehab Past Accepting new patients

Locations

3074 Brickhouse Ct
Virginia Beach, VA 23452
Phone (757) 227-4100

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1243123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1457586133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3074 BRICKHOUSE CT",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234526859",
            "telephone_number": "757-227-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3074 BRICKHOUSE CT",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234526859",
            "telephone_number": "757-227-4100",
            "fax_number": "757-963-9157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFRIES-FERNANDEZ",
        "first_name": "TIFFANY",
        "middle_name": "LOGAN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-24",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "104556510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; 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.