| NPI | 1184129694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED WILSON Owner/Doctor 541-341-1414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OR 3956) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2020-03-24 |