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General NPI Number Information
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NPI Number | 1770623811
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Entity Type | Individual
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Provider Name | PETER JOHN ROSCOE DC
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 2821 N BALLAS RD STE C55
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2386
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Country | US
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Telephone | 314-989-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 2821 N BALLAS RD STE C55
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2386
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Country | US
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Telephone | 314-542-2205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2001020193
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License Number State | MO
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