| NPI | 1811142300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGGIE STANLEY FULLER Chiropractor/President 952-746-5352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5014) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2008-11-25 |