Provider Demographics
NPI:1568145076
Name:THERIAULT CHIROPRACTIC & ASSOCIATES PC
Entity Type:Organization
Organization Name:THERIAULT CHIROPRACTIC & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:THERIAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-222-2118
Mailing Address - Street 1:381 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1361
Mailing Address - Country:US
Mailing Address - Phone:207-222-2118
Mailing Address - Fax:207-222-2145
Practice Address - Street 1:381 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1361
Practice Address - Country:US
Practice Address - Phone:207-222-2118
Practice Address - Fax:207-222-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty