Healthcare Provider Details

I. General information

NPI: 1093585226
Provider Name (Legal Business Name): PROFICIENT CHIROPRACTIC WEST END
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 UNION BLVD
SAINT LOUIS MO
63108-1229
US

IV. Provider business mailing address

2050 WOODSON RD STE 101
OVERLAND 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 Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. XAIVIER TIPLER
Title or Position: MANAGER
Credential: DC
Phone: 314-447-0725