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General NPI Number Information
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NPI Number | 1073796215
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Entity Type | Organization
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Legal Business Name | M.T. HARVEY ENTERPRISES LLC
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 1212 STUBBS AVE
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City | MONROE
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State | LA
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Zip | 71201-5622
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Country | US
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Telephone | 318-325-6685
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Fax | 318-322-7425
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Provider Business Mailing Address
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Address Line | 1212 STUBBS AVE
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City | MONROE
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State | LA
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Zip | 71201-5622
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Country | US
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Telephone | 318-325-6685
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Fax | 318-322-7425
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | MICHAEL TODD HARVEY
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Credential | D.C.
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Telephone | 318-325-6685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1134
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License Number State | LA
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