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General NPI Number Information
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NPI Number | 1255521266
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Entity Type | Organization
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Legal Business Name | KEYS SPINAL DECOMPRESSION
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 3712 N ROOSEVELT BLVD
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City | KEY WEST
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State | FL
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Zip | 33040-4533
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Country | US
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Telephone | 305-295-9755
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 OVERSEAS HWY SUITE 7
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City | MARATHON
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State | FL
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Zip | 33050-2735
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Country | US
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Telephone | 305-743-0756
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK RICHARD FELTS
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Credential | D.C
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Telephone | 305-743-0039
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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 | CH9362
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH7071
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License Number State | FL
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