Provider Demographics
NPI:1831704139
Name:KASPERSKI, ROBERT MATTHEW JOHN (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MATTHEW JOHN
Last Name:KASPERSKI
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 1:146 DEVEREAUX CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1813
Mailing Address - Country:US
Mailing Address - Phone:937-554-1523
Mailing Address - Fax:
Practice Address - Street 1:21 DAIGLE LN STE 103
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3939
Practice Address - Country:US
Practice Address - Phone:207-324-7098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor