Provider Demographics
NPI:1164643680
Name:TIPLER CHIROPRACTIC & REHABILITATION LLC
Entity Type:Organization
Organization Name:TIPLER CHIROPRACTIC & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:XAIVIER
Authorized Official - Middle Name:T
Authorized Official - Last Name:TIPLER
Authorized Official - Suffix:SR
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:SAINT LOUIS
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 1:2050 WOODSON RD STE 101
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-5644
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:2007-05-01
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006030819111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty