| NPI | 1104082064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANDON J THOMPSON President 703-777-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: VA 0104001181) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2010-08-17 |