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Individual
JEA SUB SONG
Active
Individual
JEA SUB SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
S03824
MD
171100000X
Acupuncturist
U02569
MD
Other
Enumeration date
06/24/2015
Last updated
01/04/2019
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