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General NPI Number Information
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NPI Number | 1619173663
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Entity Type | Organization
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Legal Business Name | GULFSIDE HEALTH & REHAB CENTER LLC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9438 US HIGHWAY 19N #182
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City | PORT RICHEY
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State | FL
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Zip | 34668
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Country | US
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Telephone | 727-848-5790
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Fax | 727-848-4260
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Provider Business Mailing Address
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Address Line | 9438 US HIGHWAY 19N #182
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City | PORT RICHEY
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State | FL
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Zip | 34668
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Country | US
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Telephone | 727-848-5790
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Fax | 727-848-4260
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPHEN DIAMANTIDES
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Credential | DC
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Telephone | 727-457-0636
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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 | CH8790
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License Number State | FL
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