Provider Demographics
NPI:1407884570
Name:PACKARD, BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:PACKARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ORRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04474-3410
Mailing Address - Country:US
Mailing Address - Phone:207-825-8809
Mailing Address - Fax:
Practice Address - Street 1:263 STATE ST STE 7
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5436
Practice Address - Country:US
Practice Address - Phone:207-825-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor