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General NPI Number Information
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NPI Number | 1376601039
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Entity Type | Organization
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Legal Business Name | MOHAVE CHIROPRACTIC CARE LLC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 1708 EL CAZADOR
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-7955
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Country | US
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Telephone | 928-763-9225
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Fax | 928-763-9224
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Provider Business Mailing Address
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Address Line | PO BOX 22698
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City | BULLHEAD CITY
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State | AZ
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Zip | 86439-2698
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Country | US
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Telephone | 928-763-9225
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Fax | 928-763-9224
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MS. ALANA M JACKSON
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Credential | DC
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Telephone | 928-763-9225
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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 | 7139
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License Number State | AZ
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