MEDICARE: ST. LOUIS UPPER CERVICAL CHIROPRACTIC LLP

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	111NN1001X	Nutrition Chiropractor
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1881245702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LOUIS UPPER CERVICAL CHIROPRACTIC LLP

Provider Business Mailing Address
First Line	:	8776 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3730
Country	:	US
Telephone Number	:	636-686-0136
Fax Number	:

Provider Business Practice Location Address
First Line	:	8776 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3730
Country	:	US
Telephone Number	:	636-686-0136
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. JOSHUA PAUL TONNIES
Credential	:	DC
Telephone Number	:	636-686-0136

Provider Enumeration Date	:	09/23/2019
Last Update Date	:	09/23/2019

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