| NPI | 1871819870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN CHARLES PETTERSEN Owner 727-474-9729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL ch8923) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL ch8772) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2010-04-15 |