| NPI | 1811056005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS KETCHERSIDE Practice Adm Corp Sec 314-849-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery |
| Additional Taxonomies | 111N00000X Chiropractor |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2011-10-26 |