| NPI | 1194983650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS GODBOUT President 847-917-3097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038010264) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2008-09-04 |