Provider Demographics
NPI:1093585226
Name:PROFICIENT CHIROPRACTIC WEST END, LLC
Entity Type:Organization
Organization Name:PROFICIENT CHIROPRACTIC WEST END, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:XAIVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-447-0725
Mailing Address - Street 1:2050 WOODSON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5644
Mailing Address - Country:US
Mailing Address - Phone:314-447-0725
Mailing Address - Fax:314-447-0726
Practice Address - Street 1:305 UNION BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1229
Practice Address - Country:US
Practice Address - Phone:314-447-0725
Practice Address - Fax:314-447-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty