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General NPI Number Information
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NPI Number | 1508151986
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Entity Type | Organization
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Legal Business Name | ALCMAG INC.
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 06/14/2011
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Provider Practice Location Address
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Address Line | 10235 NE HOLLADAY ST
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City | PORTLAND
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State | OR
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Zip | 97220-3920
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Country | US
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Telephone | 503-252-1731
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Fax |
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Provider Business Mailing Address
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Address Line | 10930 SE CHERRY BLOSSOM DR
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City | PORTLAND
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State | OR
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Zip | 97216-3110
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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 | CEO
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Name | MR. COLE MAGBANUA
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Credential | L.AC.
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Telephone | 503-252-1731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00386
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License Number State | OR
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