Healthcare Provider Details

I. General information

NPI: 1275690638
Provider Name (Legal Business Name): TRI DOCTORS REHABILITATION GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 WESTLINE INDUSTRIAL DR
SAINT LOUIS MO
63146-3200
US

IV. Provider business mailing address

11911 WESTLINE INDUSTRIAL DR
SAINT LOUIS MO
63146-3200
US

V. Phone/Fax

Practice location:
  • Phone: 636-394-1200
  • Fax: 314-569-1623
Mailing address:
  • Phone: 636-394-1200
  • Fax: 314-569-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL S BUTLER
Title or Position: MEMBER
Credential: D.C.,R NCS T
Phone: 636-394-1200