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General NPI Number Information
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NPI Number | 1679707731
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Entity Type | Organization
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Legal Business Name | PORTER CHIROPRACTIC CLINIC PC
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 122 W WASHINGTON ST
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City | WARSAW
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State | MO
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Zip | 65355
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Country | US
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Telephone | 660-438-5511
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Fax |
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Provider Business Mailing Address
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Address Line | 122 W WASHINGTON ST PO BOX 532
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City | WARSAW
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State | MO
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Zip | 65355
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Country | US
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Telephone | 660-438-5511
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. LEO I PORTER
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Credential | D.C.
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Telephone | 660-438-5511
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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 | 005505
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License Number State | MO
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