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General NPI Number Information
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NPI Number | 1407136591
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Entity Type | Individual
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Provider Name | DUSTIN JAMES ROSE D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 4909 GOLDEN TRIANGLE BLVD STE 221
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City | FORT WORTH
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State | TX
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Zip | 76244-4480
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Country | US
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Telephone | 214-704-4144
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Fax | 817-367-9216
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Provider Business Mailing Address
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Address Line | 3529 HERITAGE TRACE PKWY SUITE 155
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City | FORT WORTH
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State | TX
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Zip | 79244-4984
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Country | US
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Telephone | 214-704-4144
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Fax | 972-317-4196
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11145
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License Number State | TX
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