Individual
LOGAN TYLER NORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
109 CHURCH ST, O FALLON, MO 63366-2894
(636) 240-2225
(636) 281-5377
Mailing address
109 CHURCH ST, O FALLON, MO 63366-2894
(636) 240-2225
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2020035024
MO
111N00000X
Chiropractor
5562
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020035024
STATE LICENSE BOARD
MO
01
—
5562
STATE LICENSE BOARD
KY
Enumeration date
01/09/2018
Last updated
10/19/2020
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