Provider Demographics
NPI:1043390081
Name:NEW ENGLAND CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:NEW ENGLAND CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LARSON-BRUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-854-2001
Mailing Address - Street 1:89 LARRABEE RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4744
Mailing Address - Country:US
Mailing Address - Phone:207-854-2001
Mailing Address - Fax:207-854-2004
Practice Address - Street 1:89 LARRABEE RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4744
Practice Address - Country:US
Practice Address - Phone:207-854-2001
Practice Address - Fax:207-854-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1284111N00000X
MECR1288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9379Medicare ID - Type UnspecifiedMEDICARE LEGACY NUMBER