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General NPI Number Information
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NPI Number | 1679853030
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Entity Type | Organization
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Legal Business Name | MID-DEL CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 5113 SE 15TH ST STE C
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City | DEL CITY
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State | OK
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Zip | 73115-3952
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Country | US
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Telephone | 405-601-0700
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Fax | 405-605-5776
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Provider Business Mailing Address
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Address Line | 5113 SE 15TH ST STE C
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City | DEL CITY
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State | OK
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Zip | 73115-3952
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Country | US
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Telephone | 405-601-0700
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Fax | 405-605-5776
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Authorized Official
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Title or Position | OWNER
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Name | DR. DALE WAYNE MAYNARD JR.
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Credential | D.C.
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Telephone | 405-601-0700
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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 | 3752
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License Number State | OK
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