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General NPI Number Information
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NPI Number | 1295067197
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Entity Type | Individual
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Provider Name | ZACHARIAH LEIGH WILSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 36 F CATOCTIN CIRCLE
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City | LEESBURG
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State | VA
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Zip | 20175-1089
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Country | US
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Telephone | 703-777-4840
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 HIGHBRIDGE ST APT. 47E
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-2411
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Country | US
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Telephone | 307-399-1807
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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 | X011950-1
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License Number State | NY
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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 | 0104557288
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License Number State | VA
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