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General NPI Number Information
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NPI Number | 1316279565
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Entity Type | Organization
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Legal Business Name | ENDEAVOR CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 26540 ACE AVE SUITE 108
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City | LEESBURG
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State | FL
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Zip | 34748-8279
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Country | US
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Telephone | 352-326-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 6053 SPINNAKER LOOP
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City | LADY LAKE
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State | FL
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Zip | 32159-5922
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Country | US
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Telephone | 352-326-5551
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KEITH L BOSTAPH
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Credential | DC
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Telephone | 352-326-5551
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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 | CH8400
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License Number State | FL
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