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General NPI Number Information
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NPI Number | 1720441413
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Entity Type | Organization
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Legal Business Name | SIGNATURE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 235 N OAK LN
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City | BLUE GRASS
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State | IA
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Zip | 52726-7706
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Country | US
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Telephone | 563-381-9051
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Fax |
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Provider Business Mailing Address
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Address Line | 235 N OAK LN PO BOX 485
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City | BLUE GRASS
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State | IA
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Zip | 52726-7706
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Country | US
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Telephone | 563-381-9051
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. ANGELA WULF
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Credential | D.C.
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Telephone | 563-381-9051
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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 | 007722
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License Number State | IA
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