Provider Demographics
NPI:1093933459
Name:TOTAL LIFE CHIROPRACTIC,P.C.
Entity Type:Organization
Organization Name:TOTAL LIFE CHIROPRACTIC,P.C.
Other - Org Name:TLC CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SOLOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-434-7771
Mailing Address - Street 1:110 FOUR SEASONS SHOPPING CENTER
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3104
Mailing Address - Country:US
Mailing Address - Phone:314-434-7771
Mailing Address - Fax:314-434-7765
Practice Address - Street 1:110 FOUR SEASONS SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3104
Practice Address - Country:US
Practice Address - Phone:314-434-7771
Practice Address - Fax:314-434-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty