Provider Demographics
NPI:1740329473
Name:DOMBROWSKI, CHRIS JEROME (DC)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:JEROME
Last Name:DOMBROWSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MCCONKEY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039
Mailing Address - Country:US
Mailing Address - Phone:207-657-5200
Mailing Address - Fax:207-657-5200
Practice Address - Street 1:2 MCCONKEY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039
Practice Address - Country:US
Practice Address - Phone:207-657-5200
Practice Address - Fax:207-657-5200
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME223230000Medicaid
MEMM3325Medicare ID - Type Unspecified
MM3325Medicare PIN
ME223230000Medicaid