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General NPI Number Information
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NPI Number | 1033557889
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Entity Type | Organization
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Legal Business Name | NORCAL INTEGRATED MEDICAL CORP
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 5637 N PERSHING AVE STE F1
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City | STOCKTON
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State | CA
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Zip | 95207-4943
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Country | US
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Telephone | 209-952-8851
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Fax |
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Provider Business Mailing Address
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Address Line | 4719 QUAIL LAKES DR # G-335
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City | STOCKTON
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State | CA
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Zip | 95207-5267
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Country | US
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Telephone | 209-952-8851
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. FRANK LAGOMARSINO
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Credential | D.C.
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Telephone | 209-952-8851
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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 | DC 27930
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License Number State | CA
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