| NPI | 1407462062 |
|---|---|
| Doing Business As | HEALTHSOURCE OF LAKE FOREST |
| Entity Type | Organization |
| Authorized Contact | DUSTIN RAY GLASS Owner 949-273-5935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2020-09-18 |