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General NPI Number Information
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NPI Number | 1609193317
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Entity Type | Organization
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Legal Business Name | CHI-MED LEASING, INC.
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 204A S GRAND ST
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City | GROVE
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State | OK
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Zip | 74344-3225
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Country | US
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Telephone | 918-786-6500
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Fax | 918-786-6500
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Provider Business Mailing Address
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Address Line | 27910 S 563 RD
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City | AFTON
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State | OK
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Zip | 74331-8076
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Country | US
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Telephone | 918-786-6500
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Fax | 918-786-6500
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHERON LEWIS
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Credential | D.C.
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Telephone | 918-786-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 3459
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License Number State | OK
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