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General NPI Number Information
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NPI Number | 1003048067
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Entity Type | Organization
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Legal Business Name | CHIROPRACTICACUPUNCTURECENTER INC
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 6399 WILSHIRE BLVD STE 807
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City | LOS ANGELES
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State | CA
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Zip | 90048-5711
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Country | US
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Telephone | 310-738-9602
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Fax |
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Provider Business Mailing Address
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Address Line | 1146 KENISTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90019-1709
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Country | US
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Telephone | 310-738-9602
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHELLE SIEGEL
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Credential |
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Telephone | 310-738-9602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC29953
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License Number State | CA
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