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General NPI Number Information
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NPI Number | 1912374737
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Entity Type | Organization
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Legal Business Name | LIFE ABUNDANT CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 173 JONESTOWN RD
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City | WINSTON SALEM
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State | NC
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Zip | 27104-4616
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Country | US
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Telephone | 806-339-2937
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Fax |
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Provider Business Mailing Address
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Address Line | 1931 WINDING RIDGE RD
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City | WINSTON SALEM
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State | NC
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Zip | 27127-5772
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Country | US
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Telephone | 806-339-2937
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEAH BETH FOSTER
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Credential | DC
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Telephone | 806-339-2937
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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 | 4510
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License Number State | NC
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