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NPI 1780036822

NPI 1780036822 : ASHLEY WIEDEL D.C., B.S. : LINCOLN, NE

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General NPI Number Information
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    NPI Number           |    1780036822
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    Entity Type          |    Individual 
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    Provider Name        |    ASHLEY WIEDEL D.C., B.S.
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    07/12/2016
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    Last Update Date     |    07/12/2016
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Provider Practice Location Address
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    Address Line         |    2855 S 70TH ST STE 101 
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    City                 |    LINCOLN
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    State                |    NE
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    Zip                  |    68506-6822
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    Country              |    US
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    Telephone            |    308-383-9676
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    3430 CASA GRANDE LN 
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    City                 |    LINCOLN
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    State                |    NE
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    Zip                  |    68516-5768
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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    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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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       |    1874
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    License Number State |    NE
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