Provider Demographics
NPI:1568522415
Name:PAPPAS, ANTHONY NICK (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:NICK
Last Name:PAPPAS
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 1:414 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1844
Mailing Address - Country:US
Mailing Address - Phone:636-937-6500
Mailing Address - Fax:636-937-6188
Practice Address - Street 1:414 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1844
Practice Address - Country:US
Practice Address - Phone:636-937-6500
Practice Address - Fax:636-937-6188
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999142633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU79129Medicare UPIN