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General NPI Number Information
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NPI Number | 1164677480
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Entity Type | Organization
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Legal Business Name | COLISEUM CHIROPRACTIC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 916 W COLISEUM BLVD STE F
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City | FORT WAYNE
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State | IN
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Zip | 46808-1291
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Country | US
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Telephone | 260-373-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 1184 W PIONEER PKWY
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City | ARLINGTON
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State | TX
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Zip | 76013-6367
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BUFFIE MIKE CAPOBIANCO
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Credential |
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Telephone | 260-373-2225
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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 |
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License Number State |
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