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General NPI Number Information
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NPI Number | 1598654006
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Entity Type | Organization
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Legal Business Name | MDSCCC
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 830 E JOHNSTOWN RD
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City | GAHANNA
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State | OH
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Zip | 43230-3815
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Country | US
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Telephone | 614-476-1121
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Fax |
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Provider Business Mailing Address
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Address Line | 5064 SHADY OAK DR
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City | HILLIARD
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State | OH
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Zip | 43026-8550
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Country | US
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Telephone | 330-285-7391
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/BUSINESS OWNER
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Name | MICHAEL D SUPLICKI
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Credential | DC
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Telephone | 330-285-7391
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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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