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General NPI Number Information
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NPI Number | 1932368719
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Entity Type | Organization
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Legal Business Name | BODY GENESIS HOLISITC HEALTH AND WELLNESS CENTER
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 937 S MANNHEIM RD
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City | WESTCHESTER
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State | IL
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Zip | 60154-2552
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Country | US
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Telephone | 708-343-3368
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Fax | 708-343-4079
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Provider Business Mailing Address
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Address Line | 937 S MANNHEIM RD
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City | WESTCHESTER
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State | IL
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Zip | 60154-2552
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Country | US
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Telephone | 708-343-3368
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Fax | 708-343-4079
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. SOLOMON A LIBURD
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Credential | DC
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Telephone | 708-343-3368
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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 | 038010603
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License Number State | IL
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