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General NPI Number Information
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NPI Number | 1528556032
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICINE AND CHIROPRACTIC REGENERATION CENTER
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 2537 LARKIN RD
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City | LEXINGTON
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State | KY
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Zip | 40503
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Country | US
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Telephone | 859-545-0043
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Fax | 502-264-9500
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Provider Business Mailing Address
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Address Line | 2725 JAMES SANDERS BLVD. SUITE A
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City | PADUCAH
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State | KY
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Zip | 42001-8501
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Country | US
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Telephone | 270-554-5114
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Fax | 270-215-4834
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MANIKA MUSGROVE
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Credential |
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Telephone | 859-545-0043
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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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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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