Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CR 1276 | ME |
NPI | 1003870569 |
---|---|
Provider Name | Dr. Aaron David Cloutier |
First Address | Portland, ME 04104-6912 |
Second Address | Wells, ME 04090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 22/07/2013 |