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General NPI Number Information
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NPI Number | 1538890769
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Entity Type | Individual
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Provider Name | ENIEL GERARDO ROLON RESTO DC
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Gender | Male
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Dates
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Enumeration Date | 06/20/2022
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 356 MOUNTAIN VIEW DR STE 200
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City | COLCHESTER
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State | VT
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Zip | 05446-5989
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Country | US
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Telephone | 802-655-2664
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Fax |
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Provider Business Mailing Address
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Address Line | 152 ALLEN RD UNIT 215
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-3804
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Country | US
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Telephone | 787-216-5000
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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 | 3786
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 006.0134191
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License Number State | VT
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