Provider Demographics
NPI:1568662047
Name:O'FALLON PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:O'FALLON PHYSICIAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TONER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-979-8660
Mailing Address - Street 1:3023 HIGHWAY K # 639
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8696
Mailing Address - Country:US
Mailing Address - Phone:636-474-2273
Mailing Address - Fax:636-474-2272
Practice Address - Street 1:1601 BRYAN RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4815
Practice Address - Country:US
Practice Address - Phone:618-979-8660
Practice Address - Fax:636-474-2272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CZVS HOLDING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-23
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007008417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty