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General NPI Number Information
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NPI Number | 1982888459
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Entity Type | Organization
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Legal Business Name | FIRST CARE REHAB
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 11317 N CENTRAL EXPY
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City | DALLAS
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State | TX
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Zip | 75243-6703
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Country | US
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Telephone | 214-335-5870
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | FRISCO
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State | TX
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Zip | 75034-0001
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Country | US
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Telephone | 214-335-5870
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Fax | 972-559-1769
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Authorized Official
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Title or Position | OWNER
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Name | DAVE BONFESUTO
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Credential | DC
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Telephone | 214-335-5870
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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 | 9057
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License Number State | TX
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