| 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 |