Provider Demographics
NPI:1083944821
Name:ATLANTIC CHIROPRACTIC LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:ATLANTIC CHIROPRACTIC LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-772-6411
Mailing Address - Street 1:449 FOREST AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2029
Mailing Address - Country:US
Mailing Address - Phone:207-772-6411
Mailing Address - Fax:207-772-6411
Practice Address - Street 1:449 FOREST AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2029
Practice Address - Country:US
Practice Address - Phone:207-772-6411
Practice Address - Fax:207-772-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty