Healthcare Provider Details

I. General information

NPI: 1912113150
Provider Name (Legal Business Name): COLLEEN MONROE LMT, DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SHORE RD BLDG 326
CAPE ELIZABETH ME
04107-1916
US

IV. Provider business mailing address

38 LONGFELLOW DR
CAPE ELIZABETH ME
04107-2223
US

V. Phone/Fax

Practice location:
  • Phone: 207-650-2493
  • Fax:
Mailing address:
  • Phone: 207-650-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR2069
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2947
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: