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General NPI Number Information
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NPI Number | 1841690831
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Entity Type | Organization
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Legal Business Name | JAY CHIROPRACTIC HEALTH AND REHABILITATION, LLC
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 80 W 7TH ST
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City | GROVE
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State | OK
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Zip | 74344-3403
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Country | US
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Telephone | 918-787-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 80 W. 7TH ST.
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City | GROVE
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State | OK
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Zip | 74344
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Country | US
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Telephone | 918-787-6700
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JENNY LYNN WITT
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Credential | CA
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Telephone | 918-787-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 3331
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License Number State | OK
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