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General NPI Number Information
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NPI Number | 1275011702
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Entity Type | Individual
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Provider Name | AMANDA LABARGE DC
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Gender | Female
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 8623 JAMESTOWN DR
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City | WINTER HAVEN
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State | FL
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Zip | 33884-4838
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Country | US
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Telephone | 248-881-6785
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Fax |
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Provider Business Mailing Address
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Address Line | 402 GATLIN AVE
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City | ORLANDO
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State | FL
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Zip | 32806-6940
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Country | US
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Telephone | 248-881-6785
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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 | CH12542
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License Number State | FL
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