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General NPI Number Information
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NPI Number | 1881742112
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Entity Type | Organization
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Legal Business Name | OPTIMUM CHIROPRACTIC AND WELLNESS PLLC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10320 W MCDOWELL RD STE N1447
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City | AVONDALE
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State | AZ
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Zip | 85323-4879
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Country | US
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Telephone | 623-936-9353
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Fax | 480-539-4685
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Provider Business Mailing Address
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Address Line | PO BOX 1102
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City | TOLLESON
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State | AZ
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Zip | 85353-1103
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Country | US
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Telephone | 623-936-9353
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Fax | 480-539-4685
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ANNETTE SMITH
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Credential | DC
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Telephone | 623-936-9353
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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 | 7371
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License Number State | AZ
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