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General NPI Number Information
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NPI Number | 1902265705
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Entity Type | Organization
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Legal Business Name | SAGE CHIROPRACTIC WELLNESS CENTER LLC
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 69 S DIXIE HWY SUITE C1
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-4186
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Country | US
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Telephone | 904-829-3348
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Fax | 904-829-3348
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Provider Business Mailing Address
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Address Line | 69 S DIXIE HWY SUITE C1
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-4186
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Country | US
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Telephone | 904-829-3348
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Fax | 904-829-3348
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Authorized Official
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Title or Position | OWNER
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Name | DR. JANICE KALA SAGE
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Credential | DC
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Telephone | 904-829-3348
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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 | CH006632
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License Number State | FL
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