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General NPI Number Information
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NPI Number | 1174821466
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Entity Type | Organization
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Legal Business Name | ROCKSIDE HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 6500 ROCKSIDE RD SUITE 160
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2368
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Country | US
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Telephone | 216-447-9704
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Fax | 216-447-9708
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Provider Business Mailing Address
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Address Line | 6500 ROCKSIDE RD SUITE 160
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2368
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Country | US
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Telephone | 216-447-9704
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Fax | 216-447-9708
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PENNY L CAPOBIANCO
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Credential |
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Telephone | 330-268-6659
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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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