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General NPI Number Information
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NPI Number | 1780300806
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Entity Type | Organization
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Legal Business Name | MOTHERROOT INTEGRATED WELLNESS
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 149 CLEAR CREEK DR UNIT 108
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City | ASHLAND
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State | OR
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Zip | 97520-1882
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Country | US
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Telephone | 541-414-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 550 HOLLY ST
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City | ASHLAND
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State | OR
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Zip | 97520-2926
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Country | US
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Telephone | 303-325-1550
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Fax |
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Authorized Official
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Title or Position | CLINIC MANAGER/ PA
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Name | CHAD BROWN
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Credential | PA-C
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Telephone | 541-414-3808
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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 |
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License Number State |
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