NPI | 1083096127 |
---|---|
Former Name | AMANDA LYNN PANUSKA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012737) |
Additional Taxonomies | 175F00000X Naturopath |
Enumeration Date | 2015-06-25 |
Last Update Date | 2017-03-24 |