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General NPI Number Information
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NPI Number | 1770167983
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Entity Type | Organization
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Legal Business Name | POSTLETHWAITE INTEGRATIVE MEDICINE PC
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 1210 W KENT AVE STE 202
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City | MISSOULA
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State | MT
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Zip | 59801-6612
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Country | US
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Telephone | 509-731-5069
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Fax |
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Provider Business Mailing Address
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Address Line | 204 RIDGEWAY DR
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City | LOLO
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State | MT
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Zip | 59847-9608
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON POSTLETHWAITE
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Credential | DO
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Telephone | 509-731-5069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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