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General NPI Number Information
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NPI Number | 1528878154
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Entity Type | Individual
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Provider Name | SAMANTHA ROSE BOSACK DC
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 275 S CHARLES RICHARD BEALL BLVD STE 101
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City | DEBARY
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State | FL
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Zip | 32713-3719
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Country | US
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Telephone | 386-243-0244
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 CORACI BLVD APT 6211
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City | PORT ORANGE
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State | FL
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Zip | 32128-7578
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Country | US
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Telephone | 724-787-8632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 15321
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License Number State | FL
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