Provider Demographics
NPI:1154306066
Name:HYLAND, PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:HYLAND
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 1:13035 OLIVE BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6173
Mailing Address - Country:US
Mailing Address - Phone:314-542-2003
Mailing Address - Fax:314-542-2007
Practice Address - Street 1:13035 OLIVE BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6173
Practice Address - Country:US
Practice Address - Phone:314-542-2003
Practice Address - Fax:314-542-2007
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005013007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201465OtherBCBS
MO681081OtherACN
MO1061750-00OtherASH
MO201465OtherBCBS
MO1061750-00OtherASH