Provider Demographics
NPI:1790807360
Name:TICHACEK, CYNTHIA LYNN (LPN, ND, DC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LYNN
Last Name:TICHACEK
Suffix:
Gender:F
Credentials:LPN, ND, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4345
Mailing Address - Country:US
Mailing Address - Phone:636-925-3933
Mailing Address - Fax:636-925-8338
Practice Address - Street 1:3737 ELM ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4345
Practice Address - Country:US
Practice Address - Phone:636-925-3933
Practice Address - Fax:636-925-8338
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000493111N00000X
MO050107164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No164W00000XNursing Service ProvidersLicensed Practical Nurse