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General NPI Number Information
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NPI Number | 1689084972
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Entity Type | Organization
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Legal Business Name | MICHAEL L MASUCCI DC LLC
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 2124 BABLER RIDGE LN
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City | WILDWOOD
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State | MO
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Zip | 63038-1178
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Country | US
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Telephone | 636-458-9356
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Fax |
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Provider Business Mailing Address
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Address Line | 2124 BABLER RIDGE LN
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City | WILDWOOD
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State | MO
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Zip | 63038-1178
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Country | US
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Telephone | 636-458-9356
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Fax |
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Authorized Official
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Title or Position | OWNER MANAGER
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Name | MICHAEL LAURENS MASUCCI
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Credential | D.C.
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Telephone | 636-458-9356
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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 | 2014013287
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License Number State | MO
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