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General NPI Number Information
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NPI Number | 1710084926
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Entity Type | Organization
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Legal Business Name | ALTA PHYSICIANS MANAGEMENT LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 322 S FLORES ST
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City | SAN ANTONIO
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State | TX
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Zip | 78204-1106
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Country | US
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Telephone | 210-222-0999
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Fax |
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Provider Business Mailing Address
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Address Line | 322 S FLORES ST
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City | SAN ANTONIO
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State | TX
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Zip | 78204-1106
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | SAL ALTAKALI
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Credential | DC
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Telephone | 210-222-0999
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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 | F006458
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License Number State | TX
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