| NPI | 1194598102 |
|---|---|
| Doing Business As | HEAD SPINE SPORT |
| Entity Type | Organization |
| Authorized Contact | CRAIG PANOS Owner 208-512-4334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2023-11-01 |