Healthcare Provider Details

I. General information

NPI: 1235682451
Provider Name (Legal Business Name): INBOX FUNCTIONAL REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MILWAUKEE ST 240
KIRKWOOD MO
63122-7356
US

IV. Provider business mailing address

2825 BURGESS LN
MAPLEWOOD MO
63143-2801
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-1502
  • Fax: 314-821-9889
Mailing address:
  • Phone: 618-322-7347
  • Fax: 314-932-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. TYLER B BRYANT
Title or Position: OWNER
Credential: D.C.
Phone: 618-322-7347