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General NPI Number Information
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NPI Number | 1952823023
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Entity Type | Individual
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Provider Name | DAN PACKMAN
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Gender | Male
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 2955 N. HWY 97, STE 105 RIVERSIDE WELLNESS, VOILA MASSAGE
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City | BEND
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State | OR
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Zip | 97703
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Country | US
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Telephone | 541-647-9483
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Fax |
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Provider Business Mailing Address
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Address Line | 61516 DIAMOND LAKE DR
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City | BEND
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State | OR
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Zip | 97702-9154
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 21532
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License Number State | OR
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