Healthcare Provider Details

I. General information

NPI: 1912959628
Provider Name (Legal Business Name): MORRISROE CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CITY CTR
PORTLAND ME
04101-6420
US

IV. Provider business mailing address

PO BOX 7640
PORTLAND ME
04112-7640
US

V. Phone/Fax

Practice location:
  • Phone: 207-699-2622
  • Fax: 207-699-2624
Mailing address:
  • Phone: 207-699-2622
  • Fax: 207-699-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCR1590
License Number StateME

VIII. Authorized Official

Name: DR. CAITLIN M. MORRISROE
Title or Position: OWNER
Credential: MS,DC
Phone: 207-699-2622