Healthcare Provider Details

I. General information

NPI: 1588826036
Provider Name (Legal Business Name): CHANDRA SASSEVILLE DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 SABATTUS ST
LEWISTON ME
04240-5430
US

IV. Provider business mailing address

416 SABATTUS ST
LEWISTON ME
04240-5430
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-3333
  • Fax: 207-786-8921
Mailing address:
  • Phone: 207-777-3333
  • Fax: 207-786-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberME421903
License Number StateME

VIII. Authorized Official

Name: MS. ROBYN L COLEMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 207-777-3333