| NPI | 1821643966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TY BENJAMIN LONG Chiropractor 208-537-7246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2019-08-06 |