Provider Demographics
NPI:1306923040
Name:COMMUNITY CHIROPRACTIC ENT INC.
Entity type:Organization
Organization Name:COMMUNITY CHIROPRACTIC ENT INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHISARI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:207-935-3500
Mailing Address - Street 1:568 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRYEBURG
Mailing Address - State:ME
Mailing Address - Zip Code:04037-1146
Mailing Address - Country:US
Mailing Address - Phone:207-935-3500
Mailing Address - Fax:207-935-7384
Practice Address - Street 1:568 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRYEBURG
Practice Address - State:ME
Practice Address - Zip Code:04037-1146
Practice Address - Country:US
Practice Address - Phone:207-935-3500
Practice Address - Fax:207-935-7384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1142Medicare ID - Type Unspecified