Healthcare Provider Details

I. General information

NPI: 1265671978
Provider Name (Legal Business Name): XEPHYR M DAY DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 MAIN PLAZA DR
WENTZVILLE MO
63385-1170
US

IV. Provider business mailing address

1023 MAIN PLAZA DR
WENTZVILLE MO
63385-1170
US

V. Phone/Fax

Practice location:
  • Phone: 636-639-8944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2009000110
License Number StateMO

VIII. Authorized Official

Name: XEPHYR DAY
Title or Position: OWNER
Credential:
Phone: 636-639-8944