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General NPI Number Information
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NPI Number | 1689874828
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Entity Type | Organization
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Legal Business Name | ARCHANGEL CLINIC OF CHIROPRACTIC
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 2215 W FERN AVE STE B
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City | MCALLEN
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State | TX
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Zip | 78501-6177
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Country | US
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Telephone | 956-292-6557
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Fax | 956-686-8069
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Provider Business Mailing Address
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Address Line | 2215 W FERN AVE STE B
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City | MCALLEN
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State | TX
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Zip | 78501-6177
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Country | US
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Telephone | 956-292-6557
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Fax | 956-868-8069
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Authorized Official
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Title or Position | OWNER
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Name | DR. REYNOL BALDERMAR RIVERA
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Credential | DC
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Telephone | 956-292-6557
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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 | 9950
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License Number State | TX
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