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General NPI Number Information
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NPI Number | 1710212220
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Entity Type | Organization
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Legal Business Name | SHAWN SCOTT CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 72925 FRED WARING DR STE. 204
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City | PALM DESERT
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State | CA
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Zip | 92260-9401
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Country | US
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Telephone | 760-340-0100
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Fax | 760-340-1125
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Provider Business Mailing Address
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Address Line | 72925 FRED WARING DR STE. 204
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City | PALM DESERT
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State | CA
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Zip | 92260-9401
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Country | US
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Telephone | 760-340-0100
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Fax | 760-340-1125
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ROBBIE LEISKE
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Credential |
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Telephone | 760-340-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 19978
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License Number State | CA
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