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General NPI Number Information
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NPI Number | 1588294920
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Entity Type | Individual
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Provider Name | MADISON KAY ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 1809 HERITAGE HILLS DR
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City | WASHINGTON
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State | MO
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Zip | 63090-4624
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Country | US
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Telephone | 515-771-8873
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Fax |
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Provider Business Mailing Address
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Address Line | 331 BRIGHTSAND CT
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City | MANCHESTER
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State | MO
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Zip | 63011-3901
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Country | US
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Telephone | 515-771-8873
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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 | 2020002621
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License Number State | MO
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