| NPI | 1538635214 |
|---|---|
| Former Legal Business Name | KENNEDY AVE WELLNESS |
| Entity Type | Organization |
| Authorized Contact | AHMAD R SPROUSE Owner/ President 219-629-2312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2022-03-01 |