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General NPI Number Information
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NPI Number | 1396303822
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Entity Type | Organization
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Legal Business Name | EASTPORT CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 4025 NE LAKEWOOD WAY STE 100
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City | LEES SUMMIT
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State | MO
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Zip | 64064-2058
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Country | US
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Telephone | 816-598-4363
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Fax | 816-709-3074
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Provider Business Mailing Address
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Address Line | 4025 NE LAKEWOOD WAY STE 100
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City | LEES SUMMIT
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State | MO
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Zip | 64064-2058
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Country | US
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Telephone | 816-598-4363
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Fax | 816-709-3074
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Authorized Official
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Title or Position | OWNER
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Name | SYRECE SHERMAN
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Credential | DC
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Telephone | 816-277-6815
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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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