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General NPI Number Information
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NPI Number | 1255420139
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Entity Type | Individual
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Provider Name | TREVOR STANLEY DOUGLASS DC, CCSP, MPH
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 462 17TH ST NE
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City | SALEM
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State | OR
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Zip | 97301-4223
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Country | US
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Telephone | 971-209-2774
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 BARNES AVE SE
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City | SALEM
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State | OR
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Zip | 97306-1539
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Country | US
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Telephone | 971-209-2774
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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 | 273119
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 273119
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License Number State | OR
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