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General NPI Number Information
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NPI Number | 1942481379
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Entity Type | Organization
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Legal Business Name | CLOUSE CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 437 S GILBERT RD STE 14
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City | MESA
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State | AZ
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Zip | 85204-2866
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Country | US
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Telephone | 480-834-9000
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Fax | 480-834-1880
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Provider Business Mailing Address
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Address Line | 437 S GILBERT RD STE 14
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City | MESA
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State | AZ
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Zip | 85204-2866
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Country | US
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Telephone | 480-834-9000
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Fax | 480-834-1880
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. RUSSELL LEROY CLOUSE
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Credential | DC
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Telephone | 480-834-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4560
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License Number State | AZ
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