| NPI | 1750461752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN T LARSON Owner 770-638-7246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR005852) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 038843) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2025-09-11 |