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General NPI Number Information
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NPI Number | 1881734952
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Entity Type | Individual
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Provider Name | LUCAS ODAHLEN D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 31942 MISSION TRL
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-4539
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Country | US
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Telephone | 951-674-7002
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Fax | 951-674-7004
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Provider Business Mailing Address
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Address Line | 24875 PRIELIPP RD UNIT 214
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City | WILDOMAR
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State | CA
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Zip | 92595-7792
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Country | US
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Telephone | 951-600-7516
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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 | 30328
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License Number State | CA
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