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NPI 1962661264

NPI 1962661264 : SCHULTZ CHIROPRACTIC LLC : CHIPPEWA FALLS, WI

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General NPI Number Information
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    NPI Number           |    1962661264
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    Entity Type          |    Organization 
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    Legal Business Name  |    SCHULTZ CHIROPRACTIC LLC 
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Dates
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    Enumeration Date     |    06/03/2008
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    Last Update Date     |    09/27/2017
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Provider Practice Location Address
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    Address Line         |    1650 HALLIE RD 
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    City                 |    CHIPPEWA FALLS
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    State                |    WI
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    Zip                  |    54729-6521
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    Country              |    US
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    Telephone            |    715-831-6052
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    Fax                  |    715-831-6141
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Provider Business Mailing Address
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    Address Line         |    1650 HALLIE RD 
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    City                 |    CHIPPEWA FALLS
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    State                |    WI
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    Zip                  |    54729-6521
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    Country              |    US
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    Telephone            |    715-831-6052
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    Fax                  |    715-831-6141
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |    DR. KEVIN E SCHULTZ 
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    Credential           |    DC
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    Telephone            |    715-831-6052
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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       |    3766-012
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    License Number State |    WI
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