Healthcare Provider Details

I. General information

NPI: 1861452922
Provider Name (Legal Business Name): MATTHEW THOMAS MCDONNELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 POST RD SUITE 2B
WELLS ME
04090-4114
US

IV. Provider business mailing address

913 POST RD SUITE 2B
WELLS ME
04090-4114
US

V. Phone/Fax

Practice location:
  • Phone: 207-641-2225
  • Fax: 207-641-2226
Mailing address:
  • Phone: 207-641-2225
  • Fax: 207-641-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR1162
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: