Provider Demographics
NPI:1780856336
Name:PORTLAND CHIROPRACTIC NEUROLOGY, LLC
Entity Type:Organization
Organization Name:PORTLAND CHIROPRACTIC NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:MACARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB
Authorized Official - Phone:207-699-5600
Mailing Address - Street 1:959 CONGRESS ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2715
Mailing Address - Country:US
Mailing Address - Phone:207-699-5600
Mailing Address - Fax:207-699-5588
Practice Address - Street 1:959 CONGRESS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2715
Practice Address - Country:US
Practice Address - Phone:207-699-5600
Practice Address - Fax:207-699-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR-1777111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty