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General NPI Number Information
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NPI Number | 1255377164
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC SPINE CENTER III
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 1564 E LANCASTER AVE
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City | PAOLI
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State | PA
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Zip | 19301-1505
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Country | US
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Telephone | 610-651-0234
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Fax | 610-651-0209
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Provider Business Mailing Address
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Address Line | 1564 E LANCASTER AVE
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City | PAOLI
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State | PA
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Zip | 19301-1505
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Country | US
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Telephone | 610-651-0234
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Fax | 610-651-0209
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Authorized Official
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Title or Position | VICE PRESIDENT CLINICAL DIRECTOR
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Name | DR. LORI ANN KALIE
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Credential | D.C.
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Telephone | 610-651-0234
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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 | DC009121
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License Number State | PA
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