Provider Demographics
NPI:1699822312
Name:WHALEN, LYNNE (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:
Last Name:WHALEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 PEARL ST STE 320
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4165
Mailing Address - Country:US
Mailing Address - Phone:207-871-0787
Mailing Address - Fax:207-871-0775
Practice Address - Street 1:66 PEARL ST STE 320
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4165
Practice Address - Country:US
Practice Address - Phone:207-871-0787
Practice Address - Fax:207-871-0775
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1254111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8794Medicare UPIN