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General NPI Number Information
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NPI Number | 1205153756
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Entity Type | Organization
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Legal Business Name | SPINE & EXTREMITY REHABILATATION
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 1107 DELAWARE AVE
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City | FORT PIERCE
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State | FL
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Zip | 34950-4048
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Country | US
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Telephone | 772-464-2200
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Fax | 772-464-2447
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Provider Business Mailing Address
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Address Line | 4465 NW ALSACE AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-8338
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Country | US
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Telephone | 772-468-4999
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Fax | 772-464-2447
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Authorized Official
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Title or Position | PRESIENT
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Name | DR. CARY RICHARD LUBET
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Credential | DC
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Telephone | 772-485-5959
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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 | CH8116
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License Number State | FL
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