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General NPI Number Information
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NPI Number | 1083944821
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Entity Type | Organization
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Legal Business Name | ATLANTIC CHIROPRACTIC LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 449 FOREST AVE 2ND FLOOR
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City | PORTLAND
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State | ME
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Zip | 04101-2029
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Country | US
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Telephone | 207-772-6411
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Fax | 207-772-6411
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Provider Business Mailing Address
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Address Line | 449 FOREST AVE 2ND FLOOR
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City | PORTLAND
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State | ME
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Zip | 04101-2029
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Country | US
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Telephone | 207-772-6411
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Fax | 207-772-6411
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHLEEN ANN NORRIS
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Credential | DC
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Telephone | 207-772-6411
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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 | 697
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License Number State | ME
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