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General NPI Number Information
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NPI Number | 1124286158
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Entity Type | Organization
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Legal Business Name | BACK PAIN CENTER PC
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 100 1ST AVE
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-3700
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Country | US
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Telephone | 610-495-8416
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 222
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City | SPRING CITY
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State | PA
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Zip | 19475-0222
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Country | US
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Telephone | 610-495-8416
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELE YVETTE HOLDING
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Credential | MD
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Telephone | 610-495-8416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | MD051973-L
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License Number State | PA
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