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General NPI Number Information
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NPI Number | 1740488089
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Entity Type | Organization
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Legal Business Name | GATES CHIROPRACTIC
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Dates
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Enumeration Date | 07/09/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 229 NW BLUE PKWY SUITE C
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City | LEES SUMMIT
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State | MO
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Zip | 64063-1869
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Country | US
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Telephone | 816-554-6926
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Fax | 816-554-6927
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Provider Business Mailing Address
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Address Line | 229 NW BLUE PKWY SUITE C
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City | LEES SUMMIT
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State | MO
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Zip | 64063-1869
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Country | US
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Telephone | 816-554-6926
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Fax | 816-554-6927
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELYN LEE GATES
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Credential | D.C.
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Telephone | 816-554-6926
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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 | 004087
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License Number State | MO
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