Healthcare Provider Details

I. General information

NPI: 1033258553
Provider Name (Legal Business Name): ANDREA KORDA-WILLERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 CONGRESS ST
PORTLAND ME
04102-2120
US

IV. Provider business mailing address

1385 CONGRESS STREET
PORTLAND ME
04102
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-2225
  • Fax:
Mailing address:
  • Phone: 207-874-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCR820
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberCR820
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: