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General NPI Number Information
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NPI Number | 1710298666
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Entity Type | Organization
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Legal Business Name | TOTAL BACK AND BODY CENTER, PLLC
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 1228 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5330
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Country | US
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Telephone | 772-878-9355
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Fax | 772-398-4988
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Provider Business Mailing Address
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Address Line | 1228 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5330
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Country | US
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Telephone | 772-878-9355
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Fax | 772-398-4988
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Authorized Official
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Title or Position | OWNER
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Name | DR. KELLY M MEREDITH
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Credential | DC
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Telephone | 772-878-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CH0006729
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License Number State | FL
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