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General NPI Number Information
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NPI Number | 1902197478
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Entity Type | Organization
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Legal Business Name | MAXIMUM BALANCE LLC
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 6950 E BELLEVIEW AVE SUITE 204
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-1618
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Country | US
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Telephone | 636-542-2360
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Fax |
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Provider Business Mailing Address
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Address Line | 7374 W OHIO AVE APT 301
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City | LAKEWOOD
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State | CO
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Zip | 80226-4989
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Country | US
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Telephone | 636-542-2360
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BONNIE DAVIS
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Credential | D.C.
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Telephone | 636-542-2360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHR-6676
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License Number State | CO
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