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General NPI Number Information
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NPI Number | 1952612269
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Entity Type | Organization
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Legal Business Name | SEATTLE BACK CLINIC P.S.INC.
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 2041 E MADISON ST
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City | SEATTLE
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State | WA
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Zip | 98122-2959
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Country | US
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Telephone | 206-325-1575
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Fax | 206-328-0514
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Provider Business Mailing Address
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Address Line | 2041 E MADISON ST
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City | SEATTLE
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State | WA
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Zip | 98122-2959
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Country | US
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Telephone | 206-325-1575
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Fax | 106-328-0514
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD LEE HAYNES
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Credential | D.C.
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Telephone | 206-325-1575
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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 | CH00001606
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License Number State | WA
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