MEDICARE: MAINELY CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CR2069	ME

General Provider Information

NPI Number	:	1174867105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINELY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1000 SHORE RD
Second Line	:	BLDG. 326
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-1916
Country	:	US
Telephone Number	:	207-650-2493
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 SHORE RD
Second Line	:	BLDG. 326
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-1916
Country	:	US
Telephone Number	:	207-650-2493
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. COLLEEN ANNE MONROE
Credential	:	D.C.
Telephone Number	:	207-650-2493

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	12/19/2012

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