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General NPI Number Information
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NPI Number | 1558612929
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CARE & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 6388 W JEFFERSON BLVD SUITE B
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City | FORT WAYNE
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State | IN
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Zip | 46804-3075
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Country | US
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Telephone | 419-203-9690
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Fax |
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Provider Business Mailing Address
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Address Line | 6388 W JEFFERSON BLVD SUITE B
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City | FORT WAYNE
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State | IN
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Zip | 46804-3075
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Country | US
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Telephone | 419-203-9690
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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. JOEL HARMAN
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Credential | D.C.
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Telephone | 419-203-9690
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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 | 08002680A
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License Number State | IN
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