NPI | 1295087575 |
---|---|
Entity Type | Organization |
Authorized Contact | JEFFERY WILSON Owner 309-343-0028 |
Organization Subpart ? | No |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician |
Additional Taxonomies | 111NN1001X Chiropractor, Nutrition |
Enumeration Date | 2012-10-10 |
Last Update Date | 2012-10-10 |