NPI | 1932672540 |
---|---|
Entity Type | Organization |
Authorized Contact | JOHNATHAN LIVINGSTON WAGNER Owner 386-290-2324 |
Organization Subpart ? | No |
Primary Taxonomy | 111N00000X Chiropractor |
Additional Taxonomies | 247100000X Radiologic Technologist |
Enumeration Date | 2019-01-07 |
Last Update Date | 2019-01-07 |