Provider Demographics
NPI:1235692385
Name:KRIS SORNBERGER OSTEOPATHIC HEALTHCARE
Entity Type:Organization
Organization Name:KRIS SORNBERGER OSTEOPATHIC HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:SORNBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-307-0816
Mailing Address - Street 1:183 SKYLINE RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2158
Mailing Address - Country:US
Mailing Address - Phone:207-907-9898
Mailing Address - Fax:
Practice Address - Street 1:1 CUMBERLAND PL STE 112
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5083
Practice Address - Country:US
Practice Address - Phone:207-307-0816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty