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General NPI Number Information
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NPI Number | 1265922421
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Entity Type | Organization
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Legal Business Name | HUB CITY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 217 W BRENTWOOD BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70506-6110
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Country | US
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Telephone | 337-565-7140
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 W PINHOOK RD STE A
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City | LAFAYETTE
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State | LA
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Zip | 70508-1504
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Country | US
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Telephone | 337-565-7140
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Fax |
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Authorized Official
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Title or Position | OWNER/ CHIROPRACTOR
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Name | DR. JASON WARD PREVOST
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Credential | DC
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Telephone | 337-565-7140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1393
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License Number State | LA
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