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General NPI Number Information
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NPI Number | 1902247216
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Entity Type | Organization
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Legal Business Name | MATHEW DEVILLE CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1981 ARTESIA BLVD
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City | REDONDO BEACH
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State | CA
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Zip | 90278-2907
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Country | US
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Telephone | 310-504-0013
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Fax |
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Provider Business Mailing Address
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Address Line | 1981 ARTESIA BLVD
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City | REDONDO BEACH
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State | CA
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Zip | 90278-2907
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Country | US
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Telephone | 310-504-0013
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATHEW JAMES DEVILLE
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Credential | DC
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Telephone | 310-504-0013
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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 | 29908
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License Number State | CA
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