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General NPI Number Information
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NPI Number | 1437426137
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Entity Type | Organization
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Legal Business Name | FIRST CHIRO REHAB CENTER INC
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 3507 LEE BLVD STE 207
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City | LEHIGH ACRES
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State | FL
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Zip | 33971-1303
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Country | US
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Telephone | 239-674-9437
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Fax | 239-674-9524
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Provider Business Mailing Address
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Address Line | 3507 LEE BLVD STE 207
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City | LEHIGH ACRES
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State | FL
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Zip | 33971-1303
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Country | US
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Telephone | 239-674-9437
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Fax | 239-674-9524
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Authorized Official
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Title or Position | PRESIDEN/PHYSICIAN
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Name | DR. OCTAVIO MICHAEL VIDAL
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Credential | DC
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Telephone | 239-674-9437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | CH6781
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License Number State | FL
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