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General NPI Number Information
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NPI Number | 1457558686
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Entity Type | Organization
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Legal Business Name | FAMILY AND ALTERNATIVE WELLNESS
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 601 MILL ST
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City | CRAWFORDSVILLE
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State | IN
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Zip | 47933-3440
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Country | US
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Telephone | 765-362-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 1627 W COUNTRY CLUB RD
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City | CRAWFORDSVILLE
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State | IN
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Zip | 47933-2206
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Country | US
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Telephone | 765-362-4551
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DELORSE LYNNE KRUG
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Credential | OFFICE MANAGER
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Telephone | 765-362-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | 02001756A
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License Number State | IN
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