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General NPI Number Information
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NPI Number | 1205542552
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Entity Type | Individual
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Provider Name | JEREMIAH BINGHAM
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Gender | Male
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 12875 US-30 SUITE 25
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City | NORTH HUNTINGDON
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State | PA
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Zip | 15642
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Country | US
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Telephone | 724-382-5576
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Fax |
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Provider Business Mailing Address
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Address Line | 2 JENNY LYNN CT APT D
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City | PITTSBURGH
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State | PA
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Zip | 15239-3504
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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 |
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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 | DC011815
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License Number State | PA
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