Provider Demographics
NPI:1114089133
Name:TIPLER, XAIVIER T (DC)
Entity Type:Individual
Prefix:DR
First Name:XAIVIER
Middle Name:T
Last Name:TIPLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 MARCUS AURELIUS WALK APT B
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3058
Mailing Address - Country:US
Mailing Address - Phone:314-878-5997
Mailing Address - Fax:
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:314-361-4650
Practice Address - Fax:314-361-4663
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006030819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO299371OtherGHP PIN
MO000000218562OtherBLUE CROSS PIN
MO425559OtherWELLCARE PIN
MO425559OtherWELLCARE PIN