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General NPI Number Information
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NPI Number | 1699338434
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Entity Type | Organization
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Legal Business Name | RENEWED WELLNESS MEDICAL CENTER LLC
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 4047 OKEECHOBEE BLVD STE 126
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3225
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Country | US
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Telephone | 561-619-8160
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Fax |
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Provider Business Mailing Address
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Address Line | 4047 OKEECHOBEE BLVD STE 126
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3225
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Country | US
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Telephone | 561-619-8160
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH TAYLOR
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Credential | DC
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Telephone | 561-723-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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