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General NPI Number Information
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NPI Number | 1639987753
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Entity Type | Organization
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Legal Business Name | GENESIS INTEGRATED MEDICINE
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 8925 W POST RD STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89148-2433
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Country | US
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Telephone | 702-849-2459
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Fax | 702-840-4701
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Provider Business Mailing Address
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Address Line | 8925 W POST RD STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89148-2433
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Country | US
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Telephone | 702-849-2459
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Fax | 702-840-4701
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Authorized Official
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Title or Position | PARTNER
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Name | RKKI BEEDLE
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Credential | DC
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Telephone | 702-849-2459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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