Healthcare Provider Details

I. General information

NPI: 1306923040
Provider Name (Legal Business Name): COMMUNITY CHIROPRACTIC ENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 MAIN ST
FRYEBURG ME
04037-1146
US

IV. Provider business mailing address

568 MAIN ST
FRYEBURG ME
04037-1146
US

V. Phone/Fax

Practice location:
  • Phone: 207-935-3500
  • Fax: 207-935-7384
Mailing address:
  • Phone: 207-935-3500
  • Fax: 207-935-7384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateME

VIII. Authorized Official

Name: MRS. DENISE E CHISARI
Title or Position: OFFICE MANAGER
Credential: M.S.
Phone: 207-935-3500