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General NPI Number Information
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NPI Number | 1174877757
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Entity Type | Organization
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Legal Business Name | S.O.B HEALTH SYSTEM LLC
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 03/22/2013
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Provider Practice Location Address
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Address Line | 335 E JIMMIE LEEDS RD SUITE A
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City | GALLOWAY
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State | NJ
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Zip | 08205-4127
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Country | US
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Telephone | 609-573-5310
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Fax | 609-241-1922
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Provider Business Mailing Address
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Address Line | 335 E JIMMIE LEEDS RD SUITE A
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City | GALLOWAY
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State | NJ
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Zip | 08205-4127
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Country | US
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Telephone | 609-573-5310
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Fax | 609-241-1922
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. EBENEZER O-A BILEWU
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Credential | D.C
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Telephone | 609-573-5310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 38MC00702600
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License Number State | NJ
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