| NPI | 1194218057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE DAVID ROSS Owner/Clinic Director 262-676-9370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.012686) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2018-06-14 |