| NPI | 1780944462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN JAMES TANNER Doctor 904-819-9110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10578) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: FL CH10578) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2012-05-29 |