| NPI | 1073146692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE M CARROLL Manager 309-502-9513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2020-02-21 |