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General NPI Number Information
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NPI Number | 1225920994
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Entity Type | Individual
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Provider Name | JACKSON RYAN HILVERS
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Gender | Male
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 720 E 4TH ST
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City | CHATTANOOGA
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State | TN
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Zip | 37403-1925
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Country | US
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Telephone | 423-425-4706
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Fax |
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Provider Business Mailing Address
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Address Line | 5628 MOUNTAIN BREEZE DR
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7412
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Country | US
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Telephone | 262-527-3757
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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