| NPI | 1801087432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL L DINGELDEIN Head Assistant 912-691-1991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 019599) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR007674) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2007-08-08 |