| NPI | 1679971501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AHMAD RA'SHAD SPROUSE Independent Contractor 219-576-2313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 080002742A) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-09 |