| NPI | 1952810996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TJODE MAURETTE MICKELSON Owner 314-398-5800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 163W00000X Registered Nurse |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2017-09-21 |