Healthcare Provider Details

I. General information

NPI: 1114089133
Provider Name (Legal Business Name): XAIVIER T TIPLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 UNION BLVD
SAINT LOUIS MO
63108-1229
US

IV. Provider business mailing address

1151 MARCUS AURELIUS WALK APT B
CHESTERFIELD MO
63017-3058
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-4650
  • Fax: 314-361-4663
Mailing address:
  • Phone: 314-878-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2006030819
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: