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General NPI Number Information
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NPI Number | 1790214609
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Entity Type | Organization
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Legal Business Name | PINNACLE INTEGRATIVE THERAPY
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 9023 E DESERT COVE AVE STE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6779
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Country | US
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Telephone | 623-308-0823
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Fax |
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Provider Business Mailing Address
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Address Line | 39816 N MESSNER WAY
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City | ANTHEM
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State | AZ
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Zip | 85086-3669
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Country | US
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Telephone | 623-308-0823
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES L CLARK JR.
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Credential | DC
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Telephone | 623-308-0823
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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 | 7094
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License Number State | AZ
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