| NPI | 1609241884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOTEUAISA WILSON Manager 863-647-0808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 111NR0400X |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |