Provider Demographics
NPI:1023311867
Name:TOWER GROVE CHIROPRACTIC AND WELLNESS
Entity type:Organization
Organization Name:TOWER GROVE CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ISRAEL
Authorized Official - Last Name:BUSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-583-8763
Mailing Address - Street 1:4932 MURDOCH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2943
Mailing Address - Country:US
Mailing Address - Phone:314-583-8763
Mailing Address - Fax:314-627-1357
Practice Address - Street 1:4932 MURDOCH AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2943
Practice Address - Country:US
Practice Address - Phone:314-583-8763
Practice Address - Fax:314-627-1357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty