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General NPI Number Information
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NPI Number | 1881880722
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Entity Type | Organization
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Legal Business Name | ACTIVE HEALTH & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 255 CHERRY ST SUITE A
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City | MILFORD
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State | CT
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Zip | 06460-3503
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Country | US
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Telephone | 203-283-5404
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Fax | 203-283-5405
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Provider Business Mailing Address
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Address Line | 255 CHERRY ST SUITE A
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City | MILFORD
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State | CT
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Zip | 06460-3503
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Country | US
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Telephone | 203-283-5404
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Fax | 203-283-5405
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL C OREFICE
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Credential | D.C.
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Telephone | 203-283-5404
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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 | 001689
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License Number State | CT
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