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General NPI Number Information
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NPI Number | 1073146692
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Entity Type | Organization
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Legal Business Name | QUAD CITIES REGENERATIVE MEDICINE, LLC
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 4101 JOHN DEERE RD STE 2
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City | MOLINE
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State | IL
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Zip | 61265-6790
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Country | US
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Telephone | 309-581-2999
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 JOHN DEERE RD STE 2
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City | MOLINE
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State | IL
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Zip | 61265-6790
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Country | US
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Telephone | 309-581-2999
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. LANCE M CARROLL
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Credential | DC
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Telephone | 309-502-9513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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