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General NPI Number Information
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NPI Number | 1538344593
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Entity Type | Organization
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Legal Business Name | BASKIN CHIROPRACTIC
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 3330 W. 177TH STREET 1E
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City | HAZEL CREST
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State | IL
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Zip | 60429
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Country | US
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Telephone | 708-466-5535
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Fax |
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Provider Business Mailing Address
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Address Line | 3610 W. 212TH PLACE
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City | MATTESON
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State | IL
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Zip | 60443
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Country | US
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Telephone | 708-466-5535
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. COSHUN BASKIN
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Credential | D.C.
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Telephone | 708-466-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 038010990
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License Number State | IL
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