Healthcare Provider Details

I. General information

NPI: 1114912664
Provider Name (Legal Business Name): KATHLEEN A NORRIS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 FOREST AVE 2ND FLOOR
PORTLAND ME
04101-2029
US

IV. Provider business mailing address

449 FOREST AVE 2ND FLOOR
PORTLAND ME
04101-2029
US

V. Phone/Fax

Practice location:
  • Phone: 207-772-6411
  • Fax: 207-772-6411
Mailing address:
  • Phone: 207-772-6411
  • Fax: 207-772-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number697
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: