| NPI | 1164821963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOREN REES Director 741-741-5300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MA 3059) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3059) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2014-11-04 |