| NPI | 1669660262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE LYNN FAULKNER Manager 618-654-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038.010972) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010972) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2010-08-26 |