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General NPI Number Information
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NPI Number | 1114192812
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MEDICINE CENTRE LLC
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 315 MAGNOLIA AVE
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City | FAIRHOPE
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State | AL
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Zip | 36532-2413
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Country | US
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Telephone | 251-990-8188
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Fax | 251-990-8159
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Provider Business Mailing Address
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Address Line | PO BOX 1390
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City | FAIRHOPE
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State | AL
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Zip | 36533-1390
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Country | US
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Telephone | 251-990-8188
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Fax | 251-990-8159
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JOHN LEE STUMP
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Credential | DC, EDD, L.AC
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Telephone | 251-990-8188
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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 | 1206
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License Number State | AL
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