MEDICARE: CHANDRA SASSEVILLE DC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	ME421903	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	022631	OTHER	ME	ANTHEM
2	172742100	OTHER	ME	HARVARD PILGRIM
3	87726	OTHER		UNITED HEALTHCARE
4	0474865	OTHER		CIGNA
5	3435525	OTHER	ME	AETNA

General Provider Information

NPI Number	:	1588826036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANDRA SASSEVILLE DC PA

Provider Business Mailing Address
First Line	:	416 SABATTUS ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240-5430
Country	:	US
Telephone Number	:	207-777-3333
Fax Number	:	207-786-8921

Provider Business Practice Location Address
First Line	:	416 SABATTUS ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240-5430
Country	:	US
Telephone Number	:	207-777-3333
Fax Number	:	207-786-8921

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. ROBYN L COLEMAN
Credential	:
Telephone Number	:	207-777-3333

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	12/09/2014

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