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General NPI Number Information
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NPI Number | 1205547437
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Entity Type | Organization
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Legal Business Name | RADIANT CHIROPRACTIC AND WELLNESS
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 2330 S HIGGINS AVE
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City | MISSOULA
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State | MT
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Zip | 59801-6923
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Country | US
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Telephone | 608-438-4448
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 TOWER ST
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City | MISSOULA
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State | MT
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Zip | 59804-6379
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Country | US
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Telephone | 608-438-4448
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMILY L DIAZ
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Credential | DC
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Telephone | 608-438-4448
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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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