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Chiropractic Providers Chiropractor Occupational Medicine

Provider NPI: 1124136056

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
705 MAIN ST  MADAWASKA, ME 04756-3030 US
Tel: 207-728-6340  Fax: 207-728-3502

Business Mailing Address:
705 MAIN ST  MADAWASKA, ME 04756-3030 US
Tel: 207-728-6340  Fax: 207-728-3502

NPI Information:
NPI: 1124136056
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y111NX0100XChiropractic Providers
Occupational Medicine

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 111NX0100X





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