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General NPI Number Information
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NPI Number | 1902173149
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Entity Type | Individual
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Provider Name | DIANA M LEDOUX DC
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Gender | Female
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 6717 ATLANTIC AVE
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City | VENTNOR CITY
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State | NJ
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Zip | 08406-2621
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Country | US
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Telephone | 609-822-1227
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Fax | 609-823-2806
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Provider Business Mailing Address
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Address Line | 452 E BAY AVE
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City | BARNEGAT
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State | NJ
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Zip | 08005-2473
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Country | US
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Telephone | 732-600-4015
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Fax | 609-698-7622
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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 | 38MC00177600
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License Number State | NJ
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