1831717701 NPI number — NASH CHIROPRACTIC LLC

Table of content: DR. ROBERT BRYAN IOPPOLO DDS (NPI 1225099906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831717701 NPI number — NASH CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NASH CHIROPRACTIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831717701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 CENTRE ON THE LK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63367-2938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-458-9236
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10447 WALNUT LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORISTELL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63348-2552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-458-9236
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JUNGERMANN
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
314-458-9236

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)