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WASHINGTON PHYSICAL THERAPY AND REHABILITATION PATIENT INFORMATION Patient Name: *Email: Address: City/State/Zip: Date of Birth: Gender: M F Home Phone #: Mobile Phone #: Referring Physician: RESPONSIBLE
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Chiro-Associates Inc 252 Main is likely a specific form or document related to the chiropractic profession, possibly pertaining to licensing, business registration, or reporting requirements.
Usually, chiropractors and chiropractic clinics that meet certain regulatory requirements are required to file the Chiro-Associates Inc 252 Main.
To fill out the Chiro-Associates Inc 252 Main, individuals should provide accurate information as specified in the instructions, which typically include personal details, business information, and any required disclosures.
The purpose of Chiro-Associates Inc 252 Main is to ensure compliance with regulatory standards for chiropractors and to track pertinent business or practitioner information.
Commonly required information may include practitioner's name, address, license number, business type, and any additional data relevant to the chiropractic practice.
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