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General NPI Number Information
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NPI Number | 1043554603
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Entity Type | Organization
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Legal Business Name | ACADIA FAMILY CHIROPRACTIC PA
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 220 STATE ST
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City | BREWER
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State | ME
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Zip | 04412-1532
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Country | US
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Telephone | 207-989-3700
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Fax | 207-989-9833
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Provider Business Mailing Address
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Address Line | 220 STATE ST
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City | BREWER
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State | ME
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Zip | 04412-1532
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Country | US
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Telephone | 207-989-3700
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Fax | 207-989-9833
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. SHARON LYNN CLARK
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Credential | D.C.
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Telephone | 207-989-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CR1106
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License Number State | ME
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