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General NPI Number Information
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NPI Number | 1700102894
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CARE CENTER OF HARTLAND
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 864 ROSE DR
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City | HARTLAND
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State | WI
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Zip | 53029-8317
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Country | US
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Telephone | 262-367-4523
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Fax | 262-367-4657
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Provider Business Mailing Address
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Address Line | PO BOX 510444
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City | NEW BERLIN
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State | WI
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Zip | 53151-0444
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Country | US
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Telephone | 262-785-1811
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Fax | 262-785-9887
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE L DRAGGOO
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Credential |
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Telephone | 262-367-4523
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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 | 3258
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License Number State | WI
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