| NPI | 1851830640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLYDE JOHNSON Owner 760-449-7641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: CO CHR.0006922) |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy (Licence: CO CHR.0006922) |
| 261QP3300X Clinic/Center Pain (Licence: CO CHR.0006922) | |
| 261QR0400X Clinic/Center Rehabilitation (Licence: CO CHR.0006922) | |
| 261QU0200X Clinic/Center Urgent Care (Licence: CO CHR.0006922) | |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2017-02-14 |