| NPI | 1811361074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN RICHARD TANKO Dr/Owner 515-777-1104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: IA 077636) |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation (Licence: IA 077636) |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2015-11-25 |