| NPI | 1912125485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT M DORRITY Managing Employee 618-398-9716 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038010515) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070014249) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-10-11 |