Healthcare Provider Details

I. General information

NPI: 1235692385
Provider Name (Legal Business Name): KRIS SORNBERGER OSTEOPATHIC HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2019
Last Update Date: 04/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CUMBERLAND PL STE 112
BANGOR ME
04401-5083
US

IV. Provider business mailing address

183 SKYLINE RD
BANGOR ME
04401-2158
US

V. Phone/Fax

Practice location:
  • Phone: 207-307-0816
  • Fax:
Mailing address:
  • Phone: 207-907-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: KRIS S. SORNBERGER
Title or Position: OWNER
Credential: DO
Phone: 207-307-0816