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General NPI Number Information
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NPI Number | 1558753319
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Entity Type | Organization
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Legal Business Name | MY CHIROPRACTOR LLC
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 3141 W MAPLE ST
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City | WICHITA
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State | KS
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Zip | 67213-2423
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Country | US
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Telephone | 316-942-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 N DENISE MARIE ST
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City | WICHITA
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State | KS
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Zip | 67212-7410
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Country | US
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Telephone | 316-942-9600
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL WILSON
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Credential | DC
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Telephone | 316-942-9600
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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 | 0104695
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License Number State | KS
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