| NPI | 1366986721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS ENRIQUE CASTILLON Owner 807-685-2862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 111N00000X Chiropractor |
| 164W00000X Licensed Practical Nurse | |
| 225100000X Physical Therapist | |
| 225700000X Massage Therapist | |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2017-05-26 |