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General NPI Number Information
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NPI Number | 1184790073
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Entity Type | Organization
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Legal Business Name | HILLCREST CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 329 NE HOOD AVE
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City | GRESHAM
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State | OR
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Zip | 97030-7449
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Country | US
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Telephone | 503-491-0388
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Fax | 503-491-0784
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Provider Business Mailing Address
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Address Line | 329 NE HOOD AVE
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City | GRESHAM
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State | OR
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Zip | 97030-7449
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Country | US
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Telephone | 503-491-0388
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Fax | 503-491-0784
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Authorized Official
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Title or Position | LLC MEMBER
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Name | DR. RYAN M THOMAS
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Credential | DC, DABCO
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Telephone | 503-491-0388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 4394
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 27-3110
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License Number State | OR
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