| NPI | 1043610116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM LANCE EBLEN Owner 360-794-7115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 225700000X Massage Therapist |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2014-08-26 |