| NPI | 1306149190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDI LYNNE MIEDEMA Owner 701-830-0431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6596) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2010-12-30 |