NPI | 1972001055 |
---|---|
Former Name | MADISON BLAIR RESCH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5683-12) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 2422-39) |
Enumeration Date | 2018-01-24 |
Last Update Date | 2021-09-10 |