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General NPI Number Information
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NPI Number | 1790956373
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Entity Type | Organization
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Legal Business Name | ATLAS CHIROPRACTIC & WELLNESS PL
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 11512 LAKE MEAD AVE UNIT 203
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9688
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Country | US
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Telephone | 904-885-2697
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Fax | 904-212-1612
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Provider Business Mailing Address
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Address Line | 11512 LAKE MEAD AVE UNIT 203
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9688
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Country | US
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Telephone | 904-885-2697
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Fax | 904-212-1612
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEANIE RAE FRANCISE FROMAN-BOHALL
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Credential | D.C.
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Telephone | 904-885-2697
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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 | CH9350
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License Number State | FL
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