Provider Demographics
NPI:1326290388
Name:MAINE CHIRORPRACTIC HEALTH CLINIC, PA
Entity Type:Organization
Organization Name:MAINE CHIRORPRACTIC HEALTH CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUC
Authorized Official - Middle Name:JASMIN
Authorized Official - Last Name:DIONNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-786-0393
Mailing Address - Street 1:120 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6053
Mailing Address - Country:US
Mailing Address - Phone:207-786-0393
Mailing Address - Fax:207-795-0661
Practice Address - Street 1:120 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6053
Practice Address - Country:US
Practice Address - Phone:207-786-0393
Practice Address - Fax:207-795-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty