| NPI | 1366797979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD NISSAN Owner 520-297-8033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: AZ 16259) |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2012-07-19 |