Provider Demographics
NPI:1316629595
Name:CALDWELL, KATHERINE (DC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:949 BRIGHTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:949 BRIGHTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1060
Practice Address - Country:US
Practice Address - Phone:207-548-5741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2931111N00000X
CT002289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor