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General NPI Number Information
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NPI Number | 1609059096
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Entity Type | Organization
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Legal Business Name | ANGELES CHIRPRACTIC CLINIC, P.S,
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 708 S RACE ST SUITE A
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City | PORT ANGELES
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State | WA
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Zip | 98362-6441
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Country | US
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Telephone | 360-457-3430
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Fax | 360-457-7032
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Provider Business Mailing Address
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Address Line | 708 S RACE ST SUITE A
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City | PORT ANGELES
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State | WA
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Zip | 98362-6441
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Country | US
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Telephone | 360-457-3430
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Fax | 360-457-7032
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEE ALLEN JACOBSON
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Credential | DC
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Telephone | 360-457-3430
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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 | 3164
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License Number State | WA
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