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General NPI Number Information
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NPI Number | 1093049611
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Entity Type | Organization
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Legal Business Name | FINGER LAKES CHIROPRACTIC & MASSAGE THERAPY, PLLC
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 87 W. MAIN ST.
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City | DRYDEN
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State | NY
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Zip | 13053
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Country | US
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Telephone | 607-844-3304
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Fax | 607-708-4191
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Provider Business Mailing Address
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Address Line | PO BOX 1153
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City | DRYDEN
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State | NY
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Zip | 13053-1153
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Country | US
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Telephone | 607-844-3304
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Fax | 607-708-4191
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JASON R COBURN
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Credential | D.C.
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Telephone | 607-844-3304
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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 | 70 011737
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License Number State | NY
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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 | 70 011401
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License Number State | NY
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