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General NPI Number Information
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NPI Number | 1922299007
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Entity Type | Organization
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Legal Business Name | PORT CHIROPRACTIC INC.
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 1000 N WISCONSIN ST
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-1285
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Country | US
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Telephone | 262-284-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 N WISCONSIN ST
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-1285
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Country | US
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Telephone | 262-284-7246
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID C REIF
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Credential | D.C.
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Telephone | 262-268-7066
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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 | 3605-012
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License Number State | WI
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