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General NPI Number Information
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NPI Number | 1871651638
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Entity Type | Organization
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Legal Business Name | SUMMIT EAGLE SPINE AND REHABILITATION PC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 360 PEAKONE DRIVE SUITE 390
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City | FRISCO
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State | CO
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Zip | 80443
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Country | US
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Telephone | 970-668-9471
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Fax | 970-668-9473
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Provider Business Mailing Address
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Address Line | PO BOX 5089
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City | FRISCO
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State | CO
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Zip | 80443-5089
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Country | US
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Telephone | 970-668-9471
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Fax | 970-668-9473
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Authorized Official
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Title or Position | OWNER
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Name | JULIE W COLLITON
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Credential | M.D.
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Telephone | 970-668-9471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 33679
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License Number State | CO
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