| NPI | 1710032057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY LEE WASILENKOFF Owner 360-892-3654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: WA CH00003418) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-08-22 |