Provider Demographics
NPI:1184831851
Name:ST. JOHN, TINA KATHLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:KATHLEEN
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8573 TANGLEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-5635
Mailing Address - Country:US
Mailing Address - Phone:440-543-6637
Mailing Address - Fax:
Practice Address - Street 1:41 N MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-3016
Practice Address - Country:US
Practice Address - Phone:440-893-0348
Practice Address - Fax:440-893-0354
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor