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General NPI Number Information
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NPI Number | 1396783700
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Entity Type | Organization
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Legal Business Name | SPINE AND JOINT REHAB CENTER
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 711 OLD BALLAS RD SUITE 105
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7051
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Country | US
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Telephone | 314-995-3008
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 66541
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City | SAINT LOUIS
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State | MO
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Zip | 63166-6541
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Country | US
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Telephone | 314-995-3008
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KHALIDA A ANWAR
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Credential | M.D.
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Telephone | 314-995-3008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2002001968
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License Number State | MO
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