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General NPI Number Information
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NPI Number | 1396823084
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Entity Type | Individual
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Provider Name | JASON NICHOLAS MOORE D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 4008 GATEWAY DR SUITE 180
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City | COLLEYVILLE
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State | TX
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Zip | 76034-7914
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Country | US
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Telephone | 817-358-0209
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Fax | 817-358-0219
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Provider Business Mailing Address
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Address Line | 1318 BAYTHORNE DR
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City | LEWISVILLE
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State | TX
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Zip | 75077-7691
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Country | US
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Telephone | 214-529-2156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 10451
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License Number State | TX
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