| NPI | 1902117237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN WADE VICKERY Chiropractor/Owner 618-622-0096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038011632) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2011-02-16 |