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General NPI Number Information
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NPI Number | 1316241078
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Entity Type | Organization
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Legal Business Name | ELEMENTAL MEDICINE
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 2915 SE BELMONT ST SUITE 1
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City | PORTLAND
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State | OR
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Zip | 97214
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Country | US
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Telephone | 503-505-9677
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Fax |
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Provider Business Mailing Address
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Address Line | 2915 SE BELMONT ST SUITE 1
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City | PORTLAND
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State | OR
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Zip | 97214
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Country | US
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Telephone | 503-505-9677
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. CARRIE N EBLING
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Credential | DC
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Telephone | 503-505-9677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | AC153123
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 8058
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 3917
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License Number State | OR
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