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General NPI Number Information
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NPI Number | 1720492663
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Entity Type | Individual
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Provider Name | KIET MICHAEL LAM D.C
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Gender | Male
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 5693 S. JONES BVLD STE 116
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City | LAS VEGAS
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State | NV
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Zip | 89118
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Country | US
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Telephone | 702-735-0212
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Fax | 702-735-0214
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Provider Business Mailing Address
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Address Line | 5693 S. JONES BVLD STE 116
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City | LAS VEGAS
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State | NV
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Zip | 89118-2530
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Country | US
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Telephone | 702-735-0212
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Fax | 702-735-0214
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | B01053
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License Number State | NV
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