| NPI | 1629458005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HA-IL LEE Member/Owner 815-705-6246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012808) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: IL 198001256) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2024-06-29 |