| NPI | 1932388519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY DAVID BROOM President 815-986-4411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 042619163) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 042619163) |
| 111NS0005X Chiropractor, Sports Physician (Licence: IL 042619163) | |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2009-03-31 |