| NPI | 1053007898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISTAN SHOCKLEY CEO 224-347-4875 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2023-04-14 |