Provider Demographics
NPI:1194057687
Name:COFFIN, ALLYSON DAFOE
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:DAFOE
Last Name:COFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:ABBOTT
Other - Last Name:DAFOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6816
Mailing Address - Country:US
Mailing Address - Phone:207-522-1737
Mailing Address - Fax:
Practice Address - Street 1:500 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6816
Practice Address - Country:US
Practice Address - Phone:207-522-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor