Healthcare Provider Details

I. General information

NPI: 1508978248
Provider Name (Legal Business Name): HOSPITAL MANIPULATIVE SERVICE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 PLEASANT VW
HARRISON ME
04040-4039
US

IV. Provider business mailing address

47 PLEASANT VW
HARRISON ME
04040-4039
US

V. Phone/Fax

Practice location:
  • Phone: 207-583-6103
  • Fax: 207-583-6096
Mailing address:
  • Phone: 207-583-6103
  • Fax: 207-583-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRYAN BECK
Title or Position: OWNER
Credential: DO
Phone: 207-870-7627