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General NPI Number Information
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NPI Number | 1417363276
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Entity Type | Organization
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Legal Business Name | MISSION CITY HEALTHCARE, PA
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 815 E RECTOR ST SUITE 105
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City | SAN ANTONIO
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State | TX
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Zip | 78216-5931
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Country | US
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Telephone | 210-366-9442
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 472561
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City | GARLAND
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State | TX
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Zip | 75047-2561
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ZACH SYVRUD
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Credential |
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Telephone | 210-315-1582
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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 | 12285
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | F2412
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License Number State | TX
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