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General NPI Number Information
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NPI Number | 1629523055
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC AND FAMILY ALTERNATIVE HEALTH FACILITY TRUST
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 3676 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-3835
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Country | US
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Telephone | 718-984-5869
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Fax | 718-984-5583
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Provider Business Mailing Address
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Address Line | 3676 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-3835
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Country | US
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Telephone | 718-984-5869
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Fax | 718-984-5583
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Authorized Official
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Title or Position | MANAGING AGENT
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Name | DR. THOMAS KEVIN HAND
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Credential | D.C.
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Telephone | 718-984-5869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 003791-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | X-002011
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License Number State | NY
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