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General NPI Number Information
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NPI Number | 1710120647
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Entity Type | Organization
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Legal Business Name | REFLECTIONS OF HEALTH INTEGRATIVE CARE CENTER, LLC
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 2950 W WASHINGTON BLVD MARTIN LUTHER KING JR. BOYS & GIRLS CLUB BLDG
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City | CHICAGO
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State | IL
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Zip | 60612-1934
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Country | US
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Telephone | 773-826-9455
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Fax | 866-403-6309
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Provider Business Mailing Address
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Address Line | 2950 W WASHINGTON BLVD MARTIN LUTHER KING JR. BOYS & GIRLS CLUB BLDG
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City | CHICAGO
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State | IL
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Zip | 60612-1934
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Country | US
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Telephone | 773-826-9455
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Fax | 866-403-6309
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Authorized Official
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Title or Position | FOUNDER/CEO/ADMINISTRATIVE DIR.
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Name | MS. THERESA ROSE STARK
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Credential | LCMT, CPFT
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Telephone | 773-826-9455
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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 | 038011180
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License Number State | IL
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