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Individual

Inactive
Sole proprietor

Provider details

NPI number

Contact information

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
AZ4137
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
23084137
STATE WORKERS COMPENSATIO
AZ
01
AZ0237310
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
Last updated
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