| NPI | 1871189340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUKAIA MITCHOM LOCKETT Owner 618-606-9119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2021-03-22 |