| NPI | 1932983590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRYL NOWAK COO 401-206-0715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center Pain |
| Additional Taxonomies | 225700000X Massage Therapist |
| 261QR0400X Clinic/Center Rehabilitation | |
| 261QV0200X Clinic/Center VA | |
| 207Q00000X Family Medicine | |
| 208VP0000X Pain Medicine Pain Medicine | |
| 111N00000X Chiropractor | |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2023-08-23 |