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Chiropractic Northwest Jim Westerman Patient Name: Date: Address City State Zip Code H. Phone W. Phone Cell Phone Email Address: SexMFMarital Status Date of Birth Age Occupation Employer Emergency
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Chiropractic Northwest is a chiropractic clinic specializing in spinal health and wellness.
Chiropractic practitioners and clinics are required to file chiropractic northwest.
Chiropractic northwest can be filled out online or submitted via mail with relevant information regarding the practice.
The purpose of chiropractic northwest is to document and report information about chiropractic practices to regulatory authorities.
Information such as name of the practice, address, contact information, licensure details, and other relevant data must be reported on chiropractic northwest.
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