| NPI | 1134635360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN LEE KEENUM Owner 228-860-5027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 1221) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS 901566) |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2018-07-10 |