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General NPI Number Information
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NPI Number | 1417328659
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Entity Type | Organization
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Legal Business Name | NOVO CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 5570 WILSON AVE SW STE L
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City | WYOMING
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State | MI
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Zip | 49418-8867
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Country | US
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Telephone | 616-259-9835
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Fax |
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Provider Business Mailing Address
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Address Line | 5570 WILSON AVE SW STE L
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City | WYOMING
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State | MI
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Zip | 49418-8867
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Country | US
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Telephone | 616-259-9835
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. JOSHUA P KONYNENBELT
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Credential | D.C., M.S.
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Telephone | 616-259-9835
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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 | 2301010340
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301010372
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License Number State | MI
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