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General NPI Number Information
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NPI Number | 1194038232
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CLINIC OF GORHAM PC INC
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 8 ELM ST
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City | GORHAM
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State | ME
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Zip | 04038-1506
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Country | US
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Telephone | 207-839-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 8 ELM ST
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City | GORHAM
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State | ME
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Zip | 04038-1506
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT LAVOIE
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Credential | D.C.
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Telephone | 207-839-6800
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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 | CR1453
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License Number State | ME
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