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General NPI Number Information
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NPI Number | 1801097746
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Entity Type | Organization
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Legal Business Name | RESTAD CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 1012 W MAIN ST
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City | MIDDLETON
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State | ID
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Zip | 83644-5270
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Country | US
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Telephone | 707-774-5232
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Fax |
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Provider Business Mailing Address
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Address Line | 1660 LOCH NESS AVE
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City | MIDDLETON
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State | ID
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Zip | 83644-7109
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Country | US
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Telephone | 707-774-5232
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Fax | 707-773-2224
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. JULIE LEE RESTAD
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Credential | DC
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Telephone | 707-774-5232
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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 | DC29715
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License Number State | CA
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