| NPI | 1164701744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN CHRISTOPHER WICKSTROM Sole Member 509-241-3088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 60139083) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2011-08-12 |