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General NPI Number Information
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NPI Number | 1992000376
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Entity Type | Organization
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Legal Business Name | CORE CHIROPRACTIC & SPINAL REHAB CENTER, LLC
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Dates
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Enumeration Date | 01/17/2011
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Last Update Date | 01/17/2011
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Provider Practice Location Address
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Address Line | 4626 S CLYDE MORRIS BLVD STE 1
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City | PORT ORANGE
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State | FL
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Zip | 32129-6402
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Country | US
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Telephone | 386-523-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 4626 S CLYDE MORRIS BLVD STE 1
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City | PORT ORANGE
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State | FL
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Zip | 32129-6402
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Country | US
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Telephone | 386-523-1300
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. GREGORY BRIGOLA
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Credential |
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Telephone | 386-523-1300
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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 | CH10194
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License Number State | FL
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