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General NPI Number Information
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NPI Number | 1487636247
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Entity Type | Organization
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Legal Business Name | OSTEOPATHIC TREATMENT CENTER P C
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 697 1675 RD
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City | DELTA
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State | CO
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Zip | 81416-3462
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Country | US
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Telephone | 970-874-9595
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Fax | 970-240-8823
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Provider Business Mailing Address
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Address Line | 697 1675 RD
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City | DELTA
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State | CO
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Zip | 81416-3462
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Country | US
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Telephone | 970-874-9595
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Fax | 970-240-8823
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHELLE JENKINS
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Credential |
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Telephone | 970-240-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 30332
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 30332
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License Number State | CO
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