| NPI | 1649743220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER STUCKEY COO 651-779-8883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2019-01-08 |