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General NPI Number Information
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NPI Number | 1649577651
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Entity Type | Individual
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Provider Name | BRYAN STEWART RISS
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Gender | Male
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 1907 NEW ROAD
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City | NORTHFIELD
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State | NJ
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Zip | 08255
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Country | US
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Telephone | 732-797-1771
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Fax | 732-797-1818
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Provider Business Mailing Address
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Address Line | 438 COMMINS WAY
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City | TOMS RIVER
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State | NJ
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Zip | 08755
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Country | US
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Telephone | 732-797-1771
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Fax | 732-797-1818
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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 | 38MC00689300
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License Number State | NJ
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