| NPI | 1073706511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC JOHN LARSON Owner 706-210-8550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA chiro07425) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: GA chiro07425) |
| Enumeration Date | 2007-08-18 |
| Last Update Date | 2020-05-27 |