Healthcare Provider Details

I. General information

NPI: 1881245702
Provider Name (Legal Business Name): ST. LOUIS UPPER CERVICAL CHIROPRACTIC LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8776 BIG BEND BLVD
WEBSTER GROVES MO
63119-3730
US

IV. Provider business mailing address

8776 BIG BEND BLVD
WEBSTER GROVES MO
63119-3730
US

V. Phone/Fax

Practice location:
  • Phone: 636-686-0136
  • Fax:
Mailing address:
  • Phone: 636-686-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA PAUL TONNIES
Title or Position: OWNER/PHYSICIAN
Credential: DC
Phone: 636-686-0136