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General NPI Number Information
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NPI Number | 1720628571
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Entity Type | Organization
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Legal Business Name | PROFUSION CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 1200 NW 17TH AVE STE 6
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2512
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Country | US
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Telephone | 561-504-6344
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Fax |
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Provider Business Mailing Address
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Address Line | 6390 BRAVA WAY
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City | BOCA RATON
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State | FL
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Zip | 33433-8235
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Country | US
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Telephone | 772-828-9559
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | DR. JASON ROBERT ALVIENE
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Credential | D.C.
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Telephone | 772-828-9559
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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 |
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License Number State |
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