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General NPI Number Information
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NPI Number | 1669585428
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Entity Type | Organization
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Legal Business Name | CLEVELAND BACK & PAIN MANAGEMENT CENTER INC.
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 2307 W 14TH ST
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City | CLEVELAND
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State | OH
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Zip | 44113-3612
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Country | US
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Telephone | 216-687-4003
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Fax | 216-687-4069
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Provider Business Mailing Address
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Address Line | 2307 W 14TH ST
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City | CLEVELAND
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State | OH
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Zip | 44113-3612
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Country | US
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Telephone | 216-687-4003
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Fax | 216-687-4069
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Authorized Official
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Title or Position | DIRECTOR/ OFFICER
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Name | DR. JOHN HARVEY NICKELS
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Credential | MD
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Telephone | 216-687-4003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 35051581
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License Number State | OH
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