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General NPI Number Information
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NPI Number | 1326183765
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Entity Type | Individual
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Provider Name | PHILLIP WADE PAUL D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 3601 HWY 34S STE 106
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City | GREENVILLE
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State | TX
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Zip | 75402
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Country | US
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Telephone | 903-309-5673
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Fax |
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Provider Business Mailing Address
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Address Line | 224 E MAIN ST PO BOX 517
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City | ROYSE CITY
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State | TX
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Zip | 75189-3723
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Country | US
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Telephone | 972-636-9008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 6468
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License Number State | TX
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