| NPI | 1902097637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MILAM Practice Manager 307-742-2082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 663) |
| Additional Taxonomies | 111N00000X Chiropractor |
| 111NS0005X Chiropractor, Sports Physician | |
| 225100000X Physical Therapist | |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2022-10-12 |