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General NPI Number Information
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NPI Number | 1669665030
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Entity Type | Organization
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Legal Business Name | PEACHTREE CITY CHIROPRACTIC
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 1117 CROSSTOWN CT.
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-2951
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Country | US
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Telephone | 770-631-3822
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Fax | 770-486-3515
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Provider Business Mailing Address
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Address Line | 1117 CROSSTOWN CT.
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-2951
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Country | US
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Telephone | 770-631-3822
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Fax | 770-486-3515
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Authorized Official
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Title or Position | OWNER
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Name | DR. HAROLD CLIFFORD BOST JR.
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Credential | D.C.
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Telephone | 770-631-3822
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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 | CHIR004673
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License Number State | GA
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