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General NPI Number Information
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NPI Number | 1437580115
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Entity Type | Organization
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Legal Business Name | CHERRY BLOSSOM CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 12/06/2013
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 1412 N BROADWAY SUITE 26
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City | LEXINGTON
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State | KY
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Zip | 40505-3157
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Country | US
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Telephone | 859-543-0252
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Fax | 859-543-0698
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Provider Business Mailing Address
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Address Line | 104 LAWSON DR SUITE 107
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City | GEORGETOWN
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State | KY
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Zip | 40324-8998
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Country | US
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Telephone | 502-898-6090
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Fax | 859-543-0698
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Authorized Official
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Title or Position | PHYSICIAN/CO-OWNER
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Name | DR. JAMES T MCMONIGLE
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Credential | DC
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Telephone | 502-868-6090
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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 |
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License Number State |
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