=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912959628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORRISROE CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 02/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CITY CTR
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04101-6420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-699-2622
-----------------------------------------------------
Fax | 207-699-2624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7640
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04112-7640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-699-2622
-----------------------------------------------------
Fax | 207-699-2624
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CAITLIN M. MORRISROE
-----------------------------------------------------
Credential | MS,DC
-----------------------------------------------------
Telephone | 207-699-2622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | CR1590
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------