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General NPI Number Information
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NPI Number | 1922630714
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Entity Type | Organization
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Legal Business Name | CHIROPRO OF LAKE ST. LOUIS, LLC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 6257 RONALD REAGAN DR
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-2665
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Country | US
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Telephone | 636-442-0607
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Fax | 636-625-2330
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Provider Business Mailing Address
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Address Line | 1231 THOUVENOT LN STE 100
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City | SHILOH
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State | IL
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Zip | 62269-7203
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Country | US
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Telephone | 618-234-8300
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Fax | 618-234-8295
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT RICE
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Credential | DC
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Telephone | 618-979-0398
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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 |
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License Number State |
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