| NPI | 1386208650 |
|---|---|
| Doing Business As | FUNCTIONAL CHIROPRACTIC AND LASER |
| Entity Type | Organization |
| Authorized Contact | JAY E WANKEN Owner 612-787-7246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2019-04-23 |