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General NPI Number Information
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NPI Number | 1063532760
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Entity Type | Organization
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Legal Business Name | RESTORED HEALTH & WELLNESS CENTER
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 4329 S PEORIA AVE SUITE 350
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City | TULSA
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State | OK
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Zip | 74105-3935
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Country | US
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Telephone | 918-712-8616
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Fax | 918-712-8612
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Provider Business Mailing Address
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Address Line | 4329 S PEORIA AVE SUITE 350
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City | TULSA
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State | OK
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Zip | 74105-3935
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Country | US
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Telephone | 918-712-8616
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Fax | 918-712-8612
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRYSTAL P LEWIS
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Credential | D.CC
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Telephone | 918-712-8616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 3690
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License Number State | OK
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