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General NPI Number Information
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NPI Number | 1457697476
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Entity Type | Organization
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Legal Business Name | MITCHELL D SIMON PC
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 697 CAMBRIDGE ST SUITE 303
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City | BRIGHTON
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State | MA
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Zip | 02135-2897
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Country | US
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Telephone | 617-206-3250
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Fax | 617-206-3252
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Provider Business Mailing Address
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Address Line | 697 CAMBRIDGE ST STE 303
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City | BRIGHTON
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State | MA
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Zip | 02135-2897
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Country | US
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Telephone | 617-206-3250
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Fax | 617-206-3252
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MITCHELL D SIMON
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Credential |
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Telephone | 617-206-3250
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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 | 774
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License Number State | MA
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