| NPI | 1407182082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDUARDO JAIME MARQUEZ Owner 815-761-4783 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care |
| Additional Taxonomies | 111N00000X Chiropractor |
| 111NS0005X Chiropractor Sports Physician | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2023-01-11 |