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General NPI Number Information
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NPI Number | 1720141013
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE AND CHIROPRACTIC REHABILITATION LLC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 22308 LAKESHORE BLVD
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City | EUCLID
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State | OH
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Zip | 44123
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Country | US
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Telephone | 216-289-2500
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Fax | 216-289-2585
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Provider Business Mailing Address
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Address Line | 22308 LAKESHORE BLVD
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City | EUCLID
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State | OH
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Zip | 44123
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Country | US
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Telephone | 216-289-2500
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Fax | 216-289-2585
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARC J ROSENBERG
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Credential | DC
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Telephone | 216-289-2500
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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 |
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License Number State |
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