| NPI | 1174875298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK WADE STICKLER Owner/Manager 254-394-0836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X (Licence: CO 6888) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CO 6888) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: CO 6891) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: CO 6888) | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2019-10-04 |