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General NPI Number Information
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NPI Number | 1376942607
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Entity Type | Organization
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Legal Business Name | CORRECTIVE CHIROPRACTIC CARE
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 719 SLEATER KINNEY RD SE STE 130
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City | LACEY
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State | WA
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Zip | 98503-1138
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Country | US
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Telephone | 360-438-1998
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Fax | 360-438-3524
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Provider Business Mailing Address
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Address Line | PO BOX 5859
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City | LACEY
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State | WA
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Zip | 98509-5859
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Country | US
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Telephone | 360-438-1998
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Fax | 360-438-3524
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | JAIME L VALIM
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Credential | LMP
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Telephone | 360-438-1998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60336655
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License Number State | WA
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