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General NPI Number Information
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NPI Number | 1427355817
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Entity Type | Organization
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Legal Business Name | WYOMING CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 02/21/2011
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Last Update Date | 02/21/2011
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Provider Practice Location Address
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Address Line | 112 E WEBSTER ST
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City | WYOMING
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State | IA
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Zip | 52362-7775
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Country | US
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Telephone | 563-659-5582
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Fax |
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Provider Business Mailing Address
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Address Line | 306 11TH ST
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City | DE WITT
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State | IA
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Zip | 52742-1404
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Country | US
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Telephone | 563-659-1667
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Fax | 563-221-9218
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | BONNIE L BAUER
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Credential | DC
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Telephone | 563-659-1667
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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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