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General NPI Number Information
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NPI Number | 1295906857
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Entity Type | Organization
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Legal Business Name | JACK MAWER
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 681 ENCINITAS BLVD SUITE 312
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City | ENCINITAS
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State | CA
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Zip | 92024-3762
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Country | US
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Telephone | 760-753-3488
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Fax | 760-753-3499
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Provider Business Mailing Address
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Address Line | 681 ENCINITAS BLVD SUITE 312
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City | ENCINITAS
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State | CA
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Zip | 92024-3762
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Country | US
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Telephone | 760-753-3488
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Fax | 760-753-3499
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK ROY MAWER
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Credential | D.C.
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Telephone | 760-753-3488
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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 | DC25984
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License Number State | CA
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