| NPI | 1396873162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY DARIN WALTERS President 505-899-0708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: NM 1354) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-08-22 |