| NPI | 1962652834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALARIE IKERD Owner 417-659-9395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2015-02-24 |