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General NPI Number Information
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NPI Number | 1740575679
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Entity Type | Organization
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Legal Business Name | MISSION CITY CHIROPRACTIC
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 17219 OCONNOR RD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78247-5678
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Country | US
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Telephone | 972-345-0206
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Fax |
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Provider Business Mailing Address
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Address Line | 28770 BERMUDA BAY WAY #204
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-1305
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Country | US
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Telephone | 972-345-0206
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAEGAN MOSELEY STANGA
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Credential | D.C.
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Telephone | 214-714-1161
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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 | 11761
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License Number State | TX
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