Healthcare Provider Details

I. General information

NPI: 1609883073
Provider Name (Legal Business Name): CRISTI CANALI DEMARCO LIC. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 FRONT ST SUITE 2
FARMINGTON ME
04938-5834
US

IV. Provider business mailing address

193 FRONT ST SUITE 2
FARMINGTON ME
04938-5834
US

V. Phone/Fax

Practice location:
  • Phone: 207-778-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC321
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: