Provider Demographics
NPI:1326541616
Name:BRUNSWICK OSTEOPATHY LLC
Entity Type:Organization
Organization Name:BRUNSWICK OSTEOPATHY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEERSINK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-222-3024
Mailing Address - Street 1:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-0691
Mailing Address - Country:US
Mailing Address - Phone:207-222-3024
Mailing Address - Fax:207-222-3024
Practice Address - Street 1:85 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3249
Practice Address - Country:US
Practice Address - Phone:207-222-3024
Practice Address - Fax:207-222-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty