| NPI | 1770703928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD R CARLSON Owner President 414-774-3870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WI 412055) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 3259024) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2020-08-22 |