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General NPI Number Information
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NPI Number | 1649762204
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Entity Type | Organization
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Legal Business Name | ONE ROSE ENTERPRISES, INC
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 2114 W ALGONQUIN RD
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156-1370
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Country | US
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Telephone | 224-678-9424
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Fax |
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Provider Business Mailing Address
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Address Line | 876 BLAZING STAR TRL
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City | CARY
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State | IL
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Zip | 60013-3305
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Country | US
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Telephone | 224-639-8142
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. CAMERON KYLE GILBERT
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Credential | DC
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Telephone | 224-639-8142
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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 | 038.012746
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License Number State | IL
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