| NPI | 1912240623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE WOMACK Owner 855-901-0911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 133NN1002X Nutritionist, Nutrition, Education | |
| 207P00000X Emergency Medicine | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2017-11-16 |