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General NPI Number Information
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NPI Number | 1912454786
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Entity Type | Individual
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Provider Name | HARVEY MITCHELL L.M.T
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Gender | Male
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 2629 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60622-8182
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Country | US
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Telephone | 872-256-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 N ROCKWELL ST
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City | CHICAGO
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State | IL
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Zip | 60622-2865
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Country | US
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Telephone | 773-896-3642
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227.015207
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License Number State | IL
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