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General NPI Number Information
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NPI Number | 1508210956
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Entity Type | Organization
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Legal Business Name | CAPITAL DISTRICT OPTIMAL HEALTH INC
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 6018 SENTINEL RD
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City | LAKE PLACID
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State | NY
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Zip | 12946-3649
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Country | US
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Telephone | 518-523-4325
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1255
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City | LAKE PLACID
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State | NY
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Zip | 12946-5255
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Country | US
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Telephone | 518-523-4325
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DR. RHIANNON CLAUSS
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Credential | D.C.
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Telephone | 404-210-8717
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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 |
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License Number State |
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