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General NPI Number Information
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NPI Number | 1669095287
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Entity Type | Organization
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Legal Business Name | COYOTE RESOLVE
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Dates
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Enumeration Date | 05/19/2020
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 12923 NW CORNELL RD STE 201
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City | PORTLAND
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State | OR
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Zip | 97229-5834
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Country | US
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Telephone | 503-646-3393
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Fax |
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Provider Business Mailing Address
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Address Line | 14355 SW ROCHESTER DR
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City | BEAVERTON
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State | OR
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Zip | 97008-4931
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | STEVE HANSON
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Credential | DC
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Telephone | 503-956-9065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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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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