| NPI | 1366771370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY DEAN JOHNSON Mgr 239-574-5559 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 207P00000X Emergency Medicine |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2024-01-26 |