| NPI | 1639624042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK THEO WISE Owner/Chief Clinician 754-900-8074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11489) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2016-08-16 |