Provider Demographics
NPI:1548315450
Name:CHASSE, CARL BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:BRIAN
Last Name:CHASSE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SAINT THOMAS ST STE 217
Mailing Address - Street 2:
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1278
Mailing Address - Country:US
Mailing Address - Phone:207-728-6722
Mailing Address - Fax:207-728-7601
Practice Address - Street 1:309 SAINT THOMAS ST STE 217
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1278
Practice Address - Country:US
Practice Address - Phone:207-728-6722
Practice Address - Fax:207-728-7601
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEU22023Medicare UPIN
MEMM3934Medicare ID - Type Unspecified