Provider Demographics
NPI:1588936538
Name:ST. LOUIS CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ST. LOUIS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BAYLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-303-3134
Mailing Address - Street 1:300 W 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1839
Mailing Address - Country:US
Mailing Address - Phone:636-938-4414
Mailing Address - Fax:636-938-4225
Practice Address - Street 1:300 W 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1839
Practice Address - Country:US
Practice Address - Phone:636-938-4414
Practice Address - Fax:636-938-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007031959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty