| NPI | 1033534706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD ALEXANDER BLACK President 502-804-3344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2014-03-04 |
| Last Update Date | 2014-03-04 |