| NPI | 1629377940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE JOSEPH WAGNER Member/Manager 360-598-3143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00003095) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2011-12-29 |