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Chiropractic Providers Chiropractor Sports Physician

Provider NPI: 1265554018

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 207-288-4292  Fax: 207-288-2234

Business Mailing Address:
38 RODICK ST  BAR HARBOR, ME 04609-1806 US
Tel: 207-288-4292  Fax: 207-288-2234

NPI Information:
NPI: 1265554018
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N111NS0005XChiropractic Providers
Sports Physician
Y111NS0005XChiropractic Providers
N111NS0005XChiropractic Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 111NS0005X





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