| NPI | 1902088594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY E GREEN CEO 800-404-6050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2007-12-05 |