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General NPI Number Information
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NPI Number | 1508035668
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE INJURY TREATMENT CENTER LLC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 8384 BAYMEADOWS RD SUITE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4412
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Country | US
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Telephone | 904-731-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 4731 W ATLANTIC AVE SUITE B 21
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City | DELRAY BEACH
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State | FL
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Zip | 33445-3897
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | ROBERT RAY SITNER
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Credential |
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Telephone | 561-495-1212
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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 | CH7715
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License Number State | FL
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