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General NPI Number Information
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NPI Number | 1164642765
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Entity Type | Organization
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Legal Business Name | ACTIVE HEALTH SERVICES
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1717 MAIN ST STE 5640
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City | DALLAS
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State | TX
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Zip | 75201-7348
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Country | US
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Telephone | 241-220-9117
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Fax | 214-220-0410
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Provider Business Mailing Address
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Address Line | PO BOX 1844
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City | DALLAS
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State | TX
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Zip | 75221-1844
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Country | US
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Telephone | 214-220-9177
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Fax | 214-220-0410
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Authorized Official
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Title or Position | CHIROPRACTOR OWNER
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Name | DR. MICHAEL FLEMING WILLIAMS
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Credential | D C
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Telephone | 214-220-3177
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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 | 6026
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License Number State | TX
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