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General NPI Number Information
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NPI Number | 1093538993
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Entity Type | Organization
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Legal Business Name | PEAKFORM CHIROPRACTIC & REHAB LLC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 575 COMMERCIAL ST
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City | EAGLE PASS
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State | TX
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Zip | 78852-4211
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Country | US
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Telephone | 830-776-1289
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Fax | 830-215-4893
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Provider Business Mailing Address
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Address Line | 575 COMMERCIAL ST
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City | EAGLE PASS
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State | TX
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Zip | 78852-4211
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Country | US
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Telephone | 830-872-0014
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW RAPHAEL SANDOVAL
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Credential | DC
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Telephone | 830-294-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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