| NPI | 1609419266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS D RICHARDSON Owner 815-993-6699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2019-10-25 |