Provider Demographics
NPI:1477826048
Name:DOLES, CHAD JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:JOSEPH
Last Name:DOLES
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 1:3303 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1114
Mailing Address - Country:US
Mailing Address - Phone:314-371-2000
Mailing Address - Fax:
Practice Address - Street 1:3303 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1114
Practice Address - Country:US
Practice Address - Phone:314-371-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3681111N00000X
MO2014000302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1477826048Medicare PIN