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General NPI Number Information
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NPI Number | 1487017307
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Entity Type | Organization
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Legal Business Name | COREFIT CHIROPRACTIC
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 1124 GLENLIVET DR
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City | ALLENTOWN
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State | PA
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Zip | 18106-3104
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Country | US
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Telephone | 610-554-8290
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Fax |
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Provider Business Mailing Address
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Address Line | 3877 HIGHPOINT DR
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City | ALLENTOWN
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State | PA
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Zip | 18103-6142
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Country | US
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Telephone | 610-554-8290
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. MARK E WALTER
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Credential | D.C
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Telephone | 610-554-8290
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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 | DC006644L
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License Number State | PA
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