| NPI | 1932973658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE L HANFORD Managing Member 920-410-9361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2024-03-11 |