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General NPI Number Information
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NPI Number | 1700115870
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Entity Type | Organization
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Legal Business Name | DR MOSES S M SMITH CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/18/2009
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Last Update Date | 12/18/2009
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Provider Practice Location Address
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Address Line | 707 W 34TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-4138
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Country | US
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Telephone | 612-824-1829
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Fax | 612-823-3808
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Provider Business Mailing Address
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Address Line | 707 W 34TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-4138
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Country | US
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Telephone | 612-824-1829
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Fax | 612-823-3808
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. MOSES SMITH
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Credential | D.C.
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Telephone | 612-824-1829
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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 | 4728
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License Number State | MN
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