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General NPI Number Information
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NPI Number | 1972781722
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC AND REHABILITATION CLINIC P L L C
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Dates
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Enumeration Date | 02/04/2008
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Last Update Date | 05/08/2014
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Provider Practice Location Address
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Address Line | 1712 S POST RD SUITE B
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City | MIDWEST CITY
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State | OK
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Zip | 73130-6604
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Country | US
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Telephone | 405-455-7555
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Fax |
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Provider Business Mailing Address
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Address Line | 1712 S POST RD STE B
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City | MIDWEST CITY
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State | OK
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Zip | 73130-6613
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Country | US
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Telephone | 405-455-7555
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JOSHUA LAYNE KOCH
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Credential | D.C.
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Telephone | 405-455-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 3870
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License Number State | OK
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