| NPI | 1972654887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WILLIAM BENNALLACK Owner 714-308-5087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 111NR0400X |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2008-06-24 |