MEDICARE: DR. XAIVIER T TIPLER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2006030819	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	299371	OTHER	MO	GHP PIN
2	000000218562	OTHER	MO	BLUE CROSS PIN
3	425559	OTHER	MO	WELLCARE PIN

General Provider Information

NPI Number	:	1114089133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. XAIVIER T TIPLER D.C.

Provider Business Mailing Address
First Line	:	1151 MARCUS AURELIUS WALK APT B
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3058
Country	:	US
Telephone Number	:	314-878-5997
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 UNION BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1229
Country	:	US
Telephone Number	:	314-361-4650
Fax Number	:	314-361-4663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	09/29/2010

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