Healthcare Provider Details

I. General information

NPI: 1073674958
Provider Name (Legal Business Name): CLYDE EDWARD FOLAND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 HOWDERSHELL RD
HAZELWOOD MO
63042-1170
US

IV. Provider business mailing address

6110 HOWDERSHELL RD
HAZELWOOD MO
63042-1170
US

V. Phone/Fax

Practice location:
  • Phone: 314-731-5300
  • Fax: 314-731-5300
Mailing address:
  • Phone: 314-731-5300
  • Fax: 314-731-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number003475
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: