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General NPI Number Information
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NPI Number | 1144487596
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Entity Type | Organization
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Legal Business Name | COMMUNITY CHIROPRACTIC OF MAINE
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 222 SAINT JOHN ST STE 216
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City | PORTLAND
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State | ME
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Zip | 04102-3057
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Country | US
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Telephone | 207-774-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 222 SAINT JOHN ST STE 216
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City | PORTLAND
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State | ME
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Zip | 04102-3057
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Country | US
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Telephone | 207-774-2663
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY C WOODWARD
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Credential | D.C.
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Telephone | 207-774-2663
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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 | CR981
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License Number State | ME
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