| NPI | 1083731608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE CARLSON Mgr 815-942-6511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 042617968) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: IL 042617968) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2008-06-26 |