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General NPI Number Information
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NPI Number | 1114249729
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Entity Type | Organization
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Legal Business Name | RENEWED LIFE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 156 HARVEST DR
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City | LOUISBURG
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State | KS
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Zip | 66053-4081
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Country | US
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Telephone | 913-837-3310
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Fax | 913-440-0511
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Provider Business Mailing Address
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Address Line | 156 HARVEST DR
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City | LOUISBURG
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State | KS
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Zip | 66053-4081
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Country | US
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Telephone | 913-837-3310
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Fax | 913-440-0511
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. DARCY RAE MONTI
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Credential | DC
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Telephone | 913-687-6604
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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 | 01-05304
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License Number State | KS
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