Healthcare Provider Details

I. General information

NPI: 1962767194
Provider Name (Legal Business Name): CRISTI DEMARCO ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
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: 207-778-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CRISTI CANALI DEMARCO
Title or Position: OWNER
Credential: L.AC.
Phone: 207-778-9700