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General NPI Number Information
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NPI Number | 1306116694
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Entity Type | Organization
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Legal Business Name | MCMINNVILLE CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 723 NE EVANS ST
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City | MCMINNVILLE
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State | OR
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Zip | 97128-3925
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Country | US
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Telephone | 503-434-9002
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Fax |
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Provider Business Mailing Address
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Address Line | 723 NE EVANS ST
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City | MCMINNVILLE
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State | OR
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Zip | 97128-3925
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Country | US
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Telephone | 503-434-9002
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER WILLIAM ANDERSON
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Credential | DC
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Telephone | 503-434-9002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 2958
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License Number State | OR
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