| NPI | 1225450042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE EDWARD JOHNSON Owner 1605-336-2010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 602) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1070) |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2014-01-14 |