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General NPI Number Information
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NPI Number | 1396258380
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Entity Type | Organization
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Legal Business Name | WEST PHILADELPHIA PAIN MANAGEMENT CENTER
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 5429 CHESTNUT ST STE G19
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3325
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Country | US
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Telephone | 215-796-9003
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Fax | 215-596-0654
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Provider Business Mailing Address
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Address Line | 600 LOUIS DR STE 202
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City | WARMINSTER
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State | PA
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Zip | 18974-2847
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Country | US
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Telephone | 215-957-5400
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Fax | 215-957-5401
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHARON KRISTOFF
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Credential |
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Telephone | 215-957-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD067744L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC004566L
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License Number State | PA
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