NPI | 1164703039 |
---|---|
Entity Type | Organization |
Authorized Contact | DERRICK JAMES BENNER President 319-243-8393 |
Organization Subpart ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007451) |
Additional Taxonomies | 261Q00000X Clinic/Center (Licence: IA 007451) |
Enumeration Date | 2011-09-06 |
Last Update Date | 2011-09-06 |