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General NPI Number Information
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NPI Number | 1083164537
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Entity Type | Organization
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Legal Business Name | BRISTOL CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/08/2016
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Last Update Date | 10/08/2016
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Provider Practice Location Address
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Address Line | 685 METACOM AVE
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City | BRISTOL
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State | RI
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Zip | 02809-5131
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Country | US
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Telephone | 401-396-9892
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Fax | 401-396-9897
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Provider Business Mailing Address
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Address Line | 685 METACOM AVE
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City | BRISTOL
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State | RI
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Zip | 02809-5131
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Country | US
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Telephone | 401-396-9892
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Fax | 401-396-9897
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Authorized Official
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Title or Position | MEMBER
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Name | DR. CAMILLA MOORE
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Credential | DC
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Telephone | 401-396-9892
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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 | DCP00617
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License Number State | RI
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