Provider Demographics
NPI:1063429397
Name:WAHL, AARON (DC)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:WAHL
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 1:15455 COUNTRY MILL CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5118
Mailing Address - Country:US
Mailing Address - Phone:314-681-8521
Mailing Address - Fax:
Practice Address - Street 1:1415 ELBRIDGE PAYNE RD
Practice Address - Street 2:SUITE 145
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-8538
Practice Address - Country:US
Practice Address - Phone:314-681-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010389111N00000X
MO2006002533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO262651566OtherEIN
MO461648916OtherEIN
ILK21332Medicare PIN