| NPI | 1265804215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JADIAN STARLA MACK Owner 701-871-8483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 947) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 949) |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2022-04-19 |