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General NPI Number Information
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NPI Number | 1073002903
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST CHIROPRACTIC OF VERONA, LLC
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 1029 N EDGE TRL
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City | VERONA
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State | WI
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Zip | 53593-1942
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Country | US
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Telephone | 608-497-1801
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Fax |
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Provider Business Mailing Address
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Address Line | 1029 N EDGE TRL
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City | VERONA
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State | WI
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Zip | 53593-1942
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Country | US
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Telephone | 608-497-1801
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/MEMBER OWNDER
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Name | DR. JILL MORK
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Credential | DC
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Telephone | 920-251-8853
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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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