Provider Demographics
NPI:1386701316
Name:SASSEVILLE, CHANDRA L (DC)
Entity type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:L
Last Name:SASSEVILLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 SABATTUS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-4115
Mailing Address - Country:US
Mailing Address - Phone:207-777-3333
Mailing Address - Fax:207-786-8921
Practice Address - Street 1:513 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-4115
Practice Address - Country:US
Practice Address - Phone:207-777-3333
Practice Address - Fax:207-786-8921
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME407560000Medicaid
ME407560000Medicaid