| NPI | 1629531603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNALEE OTT Billing Manager 267-368-5558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| 225400000X Rehabilitation Practitioner | |
| 225700000X Massage Therapist | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2019-04-08 |