Provider Demographics
NPI:1639472657
Name:PULVER, JOEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:PULVER
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:PO BOX 31091
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-0091
Mailing Address - Country:US
Mailing Address - Phone:314-610-1618
Mailing Address - Fax:
Practice Address - Street 1:1034 PASTURE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63304-8557
Practice Address - Country:US
Practice Address - Phone:314-610-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCEO 004950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor