| NPI | 1225572563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH BRONSON WALTERS Owner 678-456-5122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: GA CHIR008932) |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2016-12-06 |