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General NPI Number Information
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NPI Number | 1962684621
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Entity Type | Organization
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Legal Business Name | ALLIANCE CHIROPRACTIC HEALTH CENTER
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 3495 WILLOW LAKE BLVD SUITE 300
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City | SAINT PAUL
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State | MN
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Zip | 55110-5138
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Country | US
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Telephone | 651-766-3855
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Fax | 651-766-7884
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Provider Business Mailing Address
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Address Line | 3495 WILLOW LAKE BLVD SUITE 300
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City | SAINT PAUL
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State | MN
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Zip | 55110-5138
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Country | US
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Telephone | 651-766-3855
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Fax | 651-766-7884
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. THOMAS OWEN AYRES
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Credential | D.C.
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Telephone | 651-766-3855
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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 | 620
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License Number State | MN
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