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General NPI Number Information
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NPI Number | 1376700542
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Entity Type | Organization
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Legal Business Name | OPTIMUM CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 2827 TRANSIT RD
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City | ELMA
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State | NY
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Zip | 14059-9635
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Country | US
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Telephone | 716-608-7075
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Fax | 716-716-1520
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Provider Business Mailing Address
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Address Line | 4721 TRANSIT RD
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City | DEPEW
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State | NY
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Zip | 14043
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Country | US
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Telephone | 716-608-7078
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Fax | 716-668-0606
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL ANGELO IMPAGLIA III
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Credential | DC
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Telephone | 716-608-7075
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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 | X009581
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License Number State | NY
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