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General NPI Number Information
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NPI Number | 1548541725
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Entity Type | Organization
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Legal Business Name | RENEW CHIROPRACTIC
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 323 SE WILSON ST
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City | LEES SUMMIT
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State | MO
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Zip | 64063-2715
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Country | US
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Telephone | 816-225-0361
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Fax |
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Provider Business Mailing Address
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Address Line | 323 SE WILSON ST
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City | LEES SUMMIT
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State | MO
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Zip | 64063-2715
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM THOMAS
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Credential |
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Telephone | 816-225-0361
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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 | 0105157
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License Number State | KS
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