| NPI | 1790300127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE BLACKWELL President 386-451-6561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2020-06-11 |