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General NPI Number Information
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NPI Number | 1063089423
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Entity Type | Organization
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Legal Business Name | ATTIVO WELLNESS LLC
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 5042 WILSHIRE BLVD STE 222
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City | LOS ANGELES
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State | CA
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Zip | 90036-4305
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Country | US
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Telephone | 310-212-7006
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 W HORIZON RIDGE PKWY # R612
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City | HENDERSON
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State | NV
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Zip | 89012-3600
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Country | US
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Telephone | 310-212-7006
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Fax | 310-212-7006
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Authorized Official
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Title or Position | OWNER, DC
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Name | EDWARD CUNNINGHAM
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Credential |
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Telephone | 310-212-7006
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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 |
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License Number State |
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