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General NPI Number Information
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NPI Number | 1942614540
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Entity Type | Organization
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Legal Business Name | FLORIDA HOLISTIC MEDICINE
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 2142 NE 123RD ST
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2902
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Country | US
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Telephone | 772-206-0638
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Fax |
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Provider Business Mailing Address
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Address Line | 11700 NW 23RD ST
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City | PLANTATION
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State | FL
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Zip | 33323-2041
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Country | US
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Telephone | 772-206-0638
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Fax | 800-948-7125
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Authorized Official
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Title or Position | OWNER
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Name | BG MANCINI
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Credential | L.AC
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Telephone | 215-783-5265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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