| NPI | 1578967188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA HOTTES Owner 618-655-0990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 038009646) |
| Additional Taxonomies | 111N00000X Chiropractor |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2024-11-19 |