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General NPI Number Information
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NPI Number | 1205339686
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Entity Type | Organization
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Legal Business Name | FALL CITY CHIROPRACTIC
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 3050 W BROADWAY STE F
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City | LOUISVILLE
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State | KY
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Zip | 40211-1475
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Country | US
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Telephone | 502-882-1752
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 W BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40211-1475
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL CLOVER
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Credential |
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Telephone | 502-882-1752
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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 |
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License Number State |
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