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General NPI Number Information
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NPI Number | 1760624563
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Entity Type | Organization
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Legal Business Name | SOMERSALL CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/26/2009
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 4670 BABCOCK ST NE SUITE 5
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City | PALM BAY
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State | FL
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Zip | 32905-2841
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Country | US
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Telephone | 321-821-7866
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Fax |
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Provider Business Mailing Address
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Address Line | 4670 BABCOCK ST NE SUITE 5
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City | PALM BAY
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State | FL
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Zip | 32905-2841
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Country | US
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Telephone | 321-821-7866
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MIA SOMERSALL HOSEY
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Credential |
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Telephone | 321-506-5462
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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 | CH9654
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License Number State | FL
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