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General NPI Number Information
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NPI Number | 1942329982
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Entity Type | Organization
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Legal Business Name | BOLINE CHIROPRACTIC CLINIC, LLC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7811 35TH AVE NE
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City | SALEM
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State | OR
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Zip | 97303-9607
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Country | US
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Telephone | 503-393-0321
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Fax |
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Provider Business Mailing Address
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Address Line | 7811 35TH AVE NE
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City | SALEM
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State | OR
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Zip | 97303-9607
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. KEITH WAYNE BOLINE
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Credential | D.C.
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Telephone | 503-393-0321
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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 | 27 1775
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License Number State | OR
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