Provider Demographics
NPI:1912113150
Name:MONROE, COLLEEN (LMT, DC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:LMT, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2223
Mailing Address - Country:US
Mailing Address - Phone:207-650-2493
Mailing Address - Fax:
Practice Address - Street 1:1000 SHORE RD
Practice Address - Street 2:BLDG 326
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-1916
Practice Address - Country:US
Practice Address - Phone:207-650-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2947174400000X
MECR2069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No174400000XOther Service ProvidersSpecialist