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General NPI Number Information
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NPI Number | 1215591532
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Entity Type | Organization
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Legal Business Name | BUENA VIDA CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 7260 VILLAGE PARK AVE STE A
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City | SPRINGDALE
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State | AR
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Zip | 72762-3074
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Country | US
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Telephone | 479-751-2332
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Fax |
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Provider Business Mailing Address
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Address Line | 18044 ASTOR DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-6654
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Country | US
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Telephone | 479-283-8296
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY ORLANDO LE
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Credential | DC
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Telephone | 479-751-2322
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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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