1548717796 NPI number — KELSEY SPENCER TOBLER CARDENAS D.C.

Table of content: KELSEY SPENCER TOBLER CARDENAS D.C. (NPI 1548717796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548717796 NPI number — KELSEY SPENCER TOBLER CARDENAS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOBLER CARDENAS
Provider First Name:
KELSEY
Provider Middle Name:
SPENCER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

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:
1548717796
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1428 N STATE HIGHWAY 47 STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63383-1375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-456-2966
Provider Business Mailing Address Fax Number:
636-456-2966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1428 N STATE HIGHWAY 47 STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63383-1375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-456-2966
Provider Business Practice Location Address Fax Number:
636-456-2977
Provider Enumeration Date:
09/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2016028432 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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