Healthcare Provider Details

I. General information

NPI: 1881948768
Provider Name (Legal Business Name): CRYSTAL THERESA ZAGWYN HARRISON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOMESTEAD WAY STE 1
RICHMOND ME
04357-3728
US

IV. Provider business mailing address

3 HOMESTEAD WAY STE 1
RICHMOND ME
04357-3728
US

V. Phone/Fax

Practice location:
  • Phone: 207-737-2482
  • Fax: 207-737-2484
Mailing address:
  • Phone: 207-737-2482
  • Fax: 207-737-2484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR2580
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCR2580
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: