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General NPI Number Information
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NPI Number | 1295272854
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Entity Type | Organization
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Legal Business Name | CLINIC OF CHIROPRACTIC HEALTH, LLC
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 141 W PIONEER AVE
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City | HOMER
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State | AK
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Zip | 99603-7525
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Country | US
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Telephone | 907-235-7146
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Fax | 907-235-7186
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Provider Business Mailing Address
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Address Line | 141 W PIONEER AVE
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City | HOMER
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State | AK
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Zip | 99603-7525
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Country | US
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Telephone | 907-235-7146
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Fax | 907-235-7186
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Authorized Official
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Title or Position | ACCOUNTS ADMINISTRATOR
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Name | FAITH H COZADD
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Credential |
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Telephone | 907-235-7146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0900X
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Taxonomy Name | Internist Chiropractor
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License Number | CHIC137
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License Number State | AK
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