Healthcare Provider Details

I. General information

NPI: 1376771204
Provider Name (Legal Business Name): CARL B CHASSE, D.C., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 SAINT THOMAS ST STE 217
MADAWASKA ME
04756-1278
US

IV. Provider business mailing address

309 SAINT THOMAS ST STE 217
MADAWASKA ME
04756-1278
US

V. Phone/Fax

Practice location:
  • Phone: 207-728-6722
  • Fax: 207-728-7601
Mailing address:
  • Phone: 207-728-6722
  • Fax: 207-728-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR736
License Number StateME

VIII. Authorized Official

Name: DR. CARL BRIAN CHASSE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 207-728-6722