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General NPI Number Information
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NPI Number | 1073043360
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Entity Type | Organization
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Legal Business Name | FAMILY SPORT AND SPINE LLC
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 196 SPRING ST APT 1
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City | PORTLAND
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State | ME
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Zip | 04102-3849
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Country | US
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Telephone | 732-822-9095
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Fax |
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Provider Business Mailing Address
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Address Line | 196 SPRING ST APT 1
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City | PORTLAND
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State | ME
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Zip | 04102-3849
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Country | US
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Telephone | 732-822-9095
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | BRITTANI F SEEMAN
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Credential | DC
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Telephone | 732-822-9095
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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 | CR2356
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License Number State | ME
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