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General NPI Number Information
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NPI Number | 1619273257
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Entity Type | Individual
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Provider Name | JOSHUA SHANE CARMON D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2011
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 5809 S LINDBERGH BLVD SUITE B
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City | SAINT LOUIS
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State | MO
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Zip | 63123-6948
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Country | US
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Telephone | 314-416-8334
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Fax | 314-416-1199
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Provider Business Mailing Address
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Address Line | 5809 S LINDBERGH BLVD SUITE B
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City | SAINT LOUIS
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State | MO
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Zip | 63123-6948
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Country | US
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Telephone | 314-416-8334
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Fax | 314-416-1199
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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 | 2010040776
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License Number State | MO
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