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General NPI Number Information
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NPI Number | 1902034465
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Entity Type | Organization
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Legal Business Name | CASTOR PRIMARY CARE LLC
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 6044 CASTOR AVE SUITE 101
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City | PHILADELPHIA
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State | PA
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Zip | 19149-3205
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Country | US
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Telephone | 215-535-5616
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Fax | 215-535-5618
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Provider Business Mailing Address
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Address Line | 6044 CASTOR AVE SUITE 101
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City | PHILADELPHIA
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State | PA
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Zip | 19149-3205
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Country | US
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Telephone | 215-535-5616
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Fax | 215-535-5618
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Authorized Official
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Title or Position | OFFICER
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Name | MR. DAVID RALIC
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Credential |
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Telephone | 215-535-5616
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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 | DC009718
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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