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General NPI Number Information
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NPI Number | 1760801310
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS HEALTH AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 393 E MAIN ST STE 8
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2575
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Country | US
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Telephone | 615-991-5951
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Fax | 503-845-6030
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Provider Business Mailing Address
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Address Line | 209 CROOKED CREEK LN
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-6713
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Country | US
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Telephone | 503-949-0235
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Fax | 503-845-9373
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. MICHAEL JOHN PETRACCI
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Credential | DC
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Telephone | 615-991-5951
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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 |
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License Number State |
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