| NPI | 1104019140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD ANTHONY KENNEDY Owner/CEO 618-310-1499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-010215) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2007-08-23 |