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General NPI Number Information
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NPI Number | 1801089776
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Entity Type | Organization
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Legal Business Name | BODY REGENERATION CENTER, LLC
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 801 ROEDER RD SUITE 425
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City | SILVER SPRING
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State | MD
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Zip | 20910-4467
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Country | US
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Telephone | 301-558-8088
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Fax | 301-558-8806
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Provider Business Mailing Address
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Address Line | 3102 LOWE LN
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-1439
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Country | US
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Telephone | 301-265-0886
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Fax | 301-265-1103
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. DUANE CLEMONS
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Credential | CEO
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Telephone | 301-841-5191
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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 |
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License Number State |
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