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General NPI Number Information
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NPI Number | 1114187663
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Entity Type | Individual
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Provider Name | MIKEL DAVENPORT L.AC.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 490 POST ST STE 900
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City | SAN FRANCISCO
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State | CA
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Zip | 94102
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Country | US
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Telephone | 415-944-9976
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Fax | 415-896-4922
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Provider Business Mailing Address
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Address Line | 490 POST ST STE 900
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-1410
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Country | US
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Telephone | 415-944-9976
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Fax | 415-896-4922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC10930
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License Number State | CA
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