| NPI | 1083439566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK J HUMBERT Owner 815-782-6903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2024-11-19 |
| Last Update Date | 2024-11-21 |