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General NPI Number Information
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NPI Number | 1881697001
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Entity Type | Individual
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Provider Name | RYAN MATTHEW HAELY D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 7500 TOWN CENTRE DR STE 300
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City | BROADVIEW HTS
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State | OH
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Zip | 44147-4009
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Country | US
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Telephone | 440-838-5755
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Fax |
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Provider Business Mailing Address
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Address Line | 6162 CARLYLE DR
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City | SEVEN HILLS
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State | OH
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Zip | 44131-2920
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Country | US
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Telephone | 216-986-1806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC 3160
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License Number State | OH
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