| NPI | 1194190322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY GRAHAM Manager 719-761-0221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2022-09-08 |