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General NPI Number Information
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NPI Number | 1194041889
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Entity Type | Organization
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Legal Business Name | ST. LOUIS LASER LLC
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 763 S NEW BALLAS RD SUITE 230
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City | CREVE COEUR
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State | MO
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Zip | 63141-8704
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Country | US
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Telephone | 314-681-2800
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Fax | 314-432-5088
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Provider Business Mailing Address
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Address Line | 16412 GREEN PINES DR
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City | BALLWIN
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State | MO
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Zip | 63011-1850
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Country | US
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Telephone | 314-681-2800
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Fax | 314-432-5088
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. SCOTT FRANK HAINZ
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Credential | DC
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Telephone | 314-378-6071
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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 | MO005286
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License Number State | MO
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