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Individual
Inactive
Individual
Inactive
Sole proprietor
Provider details
NPI number
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
X003043
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P675667
OXFORD ID
NY
Enumeration date
—
Last updated
—
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