| NPI | 1346686870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY WAGONER Owner 310-734-2040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 28876) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8098) |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2013-05-10 |