Provider Demographics
NPI:1467874958
Name:HEALTHWORX, LLC
Entity Type:Organization
Organization Name:HEALTHWORX, LLC
Other - Org Name:HEALTHSOURCE OF PORTLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-780-1070
Mailing Address - Street 1:949 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1060
Mailing Address - Country:US
Mailing Address - Phone:207-780-1070
Mailing Address - Fax:207-780-1007
Practice Address - Street 1:949 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1060
Practice Address - Country:US
Practice Address - Phone:207-780-1070
Practice Address - Fax:207-780-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty