| NPI | 1962891432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYSON WLILIAN DEVEREUX Chiropractor 208-608-8283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: ID CHIA-1540) |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2015-01-21 |