| NPI | 1356635031 |
|---|---|
| Former Name | LATRICE SHANEE JORDAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008821) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012307) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2016-08-22 |