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General NPI Number Information
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NPI Number | 1851788780
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Entity Type | Organization
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Legal Business Name | FLETCHER FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 1700 WILDCAT DR SUITE C
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City | PORTLAND
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State | TX
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Zip | 78374-2817
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Country | US
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Telephone | 361-643-2225
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Fax | 361-643-2227
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Provider Business Mailing Address
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Address Line | 1700 WILDCAT DR SUITE C
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City | PORTLAND
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State | TX
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Zip | 78374-2817
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Country | US
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Telephone | 361-643-2225
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Fax | 361-643-2227
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Authorized Official
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Title or Position | OWNER
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Name | WALKER LANDEN FLETCHER
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Credential | DC
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Telephone | 361-643-2225
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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 | 8813
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License Number State | TX
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