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General NPI Number Information
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NPI Number | 1699456913
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Entity Type | Individual
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Provider Name | SAMANTHA DERILUS DC
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Gender | Female
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Dates
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Enumeration Date | 07/28/2023
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 1707 W REYNOLDS ST UNIT 102
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City | PLANT CITY
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State | FL
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Zip | 33563-4737
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Country | US
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Telephone | 813-848-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 17438 81ST LN N
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-2927
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Country | US
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Telephone | 561-506-8854
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH14627
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License Number State | FL
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