| NPI | 1679953707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANELE SMITH Manager 239-260-0530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038012795) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012797) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2025-02-27 |