Healthcare Provider Details

I. General information

NPI: 1114674041
Provider Name (Legal Business Name): ASHLEY TANKERSLEY DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S HANLEY RD STE 130
SAINT LOUIS MO
63105-3418
US

IV. Provider business mailing address

440 W POINT CT
SAINT LOUIS MO
63130-4032
US

V. Phone/Fax

Practice location:
  • Phone: 314-862-5700
  • Fax: 314-862-6258
Mailing address:
  • Phone: 636-734-4751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ASHLEY ADELE TANKERSLEY
Title or Position: OWNER
Credential: DC
Phone: 636-734-4751