| NPI | 1396866091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ELAINE IVY Office Manager 618-235-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038009151) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |