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General NPI Number Information
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NPI Number | 1669359782
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Entity Type | Organization
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Legal Business Name | PRIMO SPINE LLC
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 1805 MAGUIRE RD STE 135
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City | WINDERMERE
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State | FL
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Zip | 34786-7924
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Country | US
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Telephone | 407-217-6969
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Fax | 407-217-6971
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Provider Business Mailing Address
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Address Line | 14414 BLACK LAKE PRESERVE ST
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City | WINTER GARDEN
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State | FL
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Zip | 34787-5242
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Country | US
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Telephone | 321-274-3951
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Fax | 407-217-6971
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Authorized Official
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Title or Position | OWNER/CHIROPRACTIC PHYSICIAN
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Name | DR. JAE SUK OH
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Credential | DC
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Telephone | 407-217-6969
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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 |
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License Number State |
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