| NPI | 1639598741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE GAEBEL DODGE Owner/Chiropractor 315-498-0243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 70012413) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: NY 70012414) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2014-04-16 |