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General NPI Number Information
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NPI Number | 1326557604
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Entity Type | Organization
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Legal Business Name | FOCUS FORWARD CHIROPRACTIC
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 900 N SWALLOW TAIL DR
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City | PORT ORANGE
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State | FL
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Zip | 32129
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Country | US
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Telephone | 518-536-0574
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 N SWALLOW TAIL DR APT 803
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City | PORT ORANGE
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State | FL
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Zip | 32129-4155
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Country | US
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Telephone | 518-536-0574
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BETHANY RAUDENBUSH
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Credential |
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Telephone | 386-872-5313
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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 |
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License Number State |
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