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 |