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General NPI Number Information
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NPI Number | 1518225150
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Entity Type | Organization
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Legal Business Name | ST MARIES CHIROPRACTIC INC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 533 MAIN AVE
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City | ST MARIES
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State | ID
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Zip | 83861-2060
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Country | US
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Telephone | 208-245-3420
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Fax | 208-245-3420
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Provider Business Mailing Address
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Address Line | 533 MAIN AVE
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City | ST MARIES
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State | ID
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Zip | 83861-2060
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Country | US
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Telephone | 208-245-3420
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Fax | 208-245-3420
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MARLENE KAY SAUNDERS
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Credential | DC
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Telephone | 208-245-3420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | CHIA 527
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License Number State | ID
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