Healthcare Provider Details

I. General information

NPI: 1164643680
Provider Name (Legal Business Name): TIPLER CHIROPRACTIC & REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 WOODSON RD STE 101
SAINT LOUIS MO
63114-5644
US

IV. Provider business mailing address

2050 WOODSON RD STE 101
SAINT LOUIS MO
63114-5644
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-0725
  • Fax: 314-447-0726
Mailing address:
  • Phone: 314-447-0725
  • Fax: 314-447-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2006030819
License Number StateMO

VIII. Authorized Official

Name: DR. XAIVIER T TIPLER SR.
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 314-447-0725