| NPI | 1801011895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSEL VINCENT ANTICO Owner 443-259-0235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MD S01939) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2013-01-17 |