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General NPI Number Information
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NPI Number | 1609408988
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Entity Type | Individual
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Provider Name | ANDREW BONNEAU
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Gender | Male
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 2415 S VOLUSIA AVE STE A2
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City | ORANGE CITY
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State | FL
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Zip | 32763-7623
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Country | US
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Telephone | 386-775-6879
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 YORKTOWNE BLVD APT 3704
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City | PORT ORANGE
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State | FL
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Zip | 32129-6016
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Country | US
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Telephone |
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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 | CH13061
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License Number State | FL
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