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General NPI Number Information
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NPI Number | 1194839654
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Entity Type | Individual
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Provider Name | SANDE R JACOBSON DC
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 9500 NORTHEAST AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19115
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Country | US
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Telephone | 215-673-9500
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Fax | 215-671-1112
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Provider Business Mailing Address
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Address Line | 1405 CENTER AVE
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City | FEASTERVILLE TREVOSE
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State | PA
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Zip | 19053-4413
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Country | US
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Telephone | 215-801-5457
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC004909L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC4909C
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License Number State | PA
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