Provider Demographics
NPI:1073898433
Name:BRINK CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:BRINK CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-324-5753
Mailing Address - Street 1:1047 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3620
Mailing Address - Country:US
Mailing Address - Phone:207-324-5753
Mailing Address - Fax:207-324-8354
Practice Address - Street 1:1047 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3620
Practice Address - Country:US
Practice Address - Phone:207-324-5753
Practice Address - Fax:207-324-8354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0022059OtherMEDICARE PTAN
MET31464Medicare UPIN