Provider Demographics
NPI:1962422378
Name:DUNPHY, FAWN RAE (DC)
Entity type:Individual
Prefix:DR
First Name:FAWN
Middle Name:RAE
Last Name:DUNPHY
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 1:85 E ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2870
Mailing Address - Country:US
Mailing Address - Phone:207-799-0972
Mailing Address - Fax:207-799-4966
Practice Address - Street 1:85 E ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2870
Practice Address - Country:US
Practice Address - Phone:207-799-0972
Practice Address - Fax:207-799-4966
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME6744257OtherCIGNA
ME025865OtherANTHEM BC BS
ME6744257OtherCIGNA