| NPI | 1962697763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA DEYOUNG Credentialing Manager 502-245-0767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 007078) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2009-10-29 |