Healthcare Provider Details

I. General information

NPI: 1689691131
Provider Name (Legal Business Name): PAUL K WEST DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 SOMERSET AVE
PITTSFIELD ME
04967-4705
US

IV. Provider business mailing address

221 SOMERSET AVE
PITTSFIELD ME
04967-4705
US

V. Phone/Fax

Practice location:
  • Phone: 207-487-5956
  • Fax: 207-487-6044
Mailing address:
  • Phone: 207-487-5956
  • Fax: 207-487-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR635
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: