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General NPI Number Information
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NPI Number | 1093933459
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Entity Type | Organization
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Legal Business Name | TOTAL LIFE CHIROPRACTIC,P.C.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 110 FOUR SEASONS SHOPPING CENTER
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3104
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Country | US
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Telephone | 314-434-7771
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Fax | 314-434-7765
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Provider Business Mailing Address
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Address Line | 110 FOUR SEASONS SHOPPING CENTER
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3104
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Country | US
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Telephone | 314-434-7771
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Fax | 314-434-7765
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD EDWARD SOLOM
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Credential | D.C.
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Telephone | 314-434-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 005521
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License Number State | MO
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