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General NPI Number Information
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NPI Number | 1942654629
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Entity Type | Organization
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Legal Business Name | PROHEALTH CHIROPRACTIC AND MASSAGE, LLC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 4880 S MAIN ST SUITE 5
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City | AKRON
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State | OH
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Zip | 44319-4474
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Country | US
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Telephone | 330-563-4033
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Fax | 330-563-4169
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Provider Business Mailing Address
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Address Line | 4880 S MAIN ST SUITE 5
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City | AKRON
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State | OH
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Zip | 44319-4474
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Country | US
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Telephone | 330-563-4033
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Fax | 330-563-4169
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK JUSTIN TAYLOR
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Credential | D.C.
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Telephone | 330-413-2628
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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 | 3983
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License Number State | OH
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