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General NPI Number Information
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NPI Number | 1851555197
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Entity Type | Organization
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Legal Business Name | AUTHENTIC SPINAL CARE
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 2900 100TH ST STE 204
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City | URBANDALE
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State | IA
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Zip | 50322-3851
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Country | US
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Telephone | 515-270-1700
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Fax | 515-270-1744
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Provider Business Mailing Address
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Address Line | 2900 100TH ST STE 204
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City | URBANDALE
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State | IA
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Zip | 50322-3851
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Country | US
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Telephone | 515-270-1700
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Fax | 515-270-1744
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LANCE EVAN KELLOW
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Credential | D.C.
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Telephone | 515-270-1700
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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 | 007063
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License Number State | IA
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