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General NPI Number Information
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NPI Number | 1790795193
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Entity Type | Organization
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Legal Business Name | BRIDGTON CHIROPRACTIC CENTER, INC.
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 55 PORTLAND RD
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City | BRIDGTON
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State | ME
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Zip | 04009-1230
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Country | US
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Telephone | 207-647-3504
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Fax | 207-647-5862
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Provider Business Mailing Address
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Address Line | 55 PORTLAND RD
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City | BRIDGTON
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State | ME
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Zip | 04009-1230
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Country | US
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Telephone | 207-647-3504
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Fax | 207-647-5862
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC, PRESIDENT
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Name | DR. STEWART ESTABROOK SULLOWAY
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Credential | D.C.
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Telephone | 207-647-3504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CR755
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License Number State | ME
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