| NPI | 1619536273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARETT LEATHEM Owner 860-670-2412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 207L00000X Anesthesiology |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2020-04-27 |