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General NPI Number Information
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NPI Number | 1144677170
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Entity Type | Individual
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Provider Name | MATHIAS RIVERS
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Gender | Male
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 700 MURDOCK ST SUITE B
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City | SEDRO WOOLLEY
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State | WA
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Zip | 98284-1426
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Country | US
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Telephone | 360-855-1021
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Fax |
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Provider Business Mailing Address
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Address Line | 280 US HIGHWAY 9
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City | MORGANVILLE
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State | NJ
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Zip | 07751-1572
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Country | US
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Telephone | 262-672-0904
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00745200
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License Number State | NJ
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