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General NPI Number Information
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NPI Number | 1699179010
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Entity Type | Organization
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Legal Business Name | RESTORATION HEALTH & CHIROPRACTIC
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 365 E. BAILEY RD.
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City | NAPERVILLE
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State | IL
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Zip | 60565
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Country | US
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Telephone | 630-506-7758
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Fax | 630-364-2133
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Provider Business Mailing Address
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Address Line | 365 E. BAILEY RD.
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City | NAPERVILLE
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State | IL
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Zip | 60565
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Country | US
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Telephone | 630-506-7758
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Fax | 630-364-2133
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Authorized Official
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Title or Position | OWNER / MANAGER
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Name | DR. COLLEEN RENEE FAZIO
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Credential | D.C.
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Telephone | 901-335-6006
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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 | 038-011411
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License Number State | IL
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