Provider Demographics
NPI:1205268299
Name:DOHERTY, MIRANDA J (DC)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:J
Last Name:DOHERTY
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 1:43A OXBOW RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:ME
Mailing Address - Zip Code:04965
Mailing Address - Country:US
Mailing Address - Phone:207-852-0684
Mailing Address - Fax:
Practice Address - Street 1:43A OXBOW RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:ME
Practice Address - Zip Code:04965
Practice Address - Country:US
Practice Address - Phone:207-852-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor