Provider Demographics
NPI:1275661571
Name:SCHALLER, DAVID BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRIAN
Last Name:SCHALLER
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 1:15825 MANCHESTER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2263
Mailing Address - Country:US
Mailing Address - Phone:636-256-4900
Mailing Address - Fax:
Practice Address - Street 1:15825 MANCHESTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2263
Practice Address - Country:US
Practice Address - Phone:636-256-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE006262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32428Medicare ID - Type Unspecified