Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CR864 | ME |
NPI | 1184603847 |
---|---|
Provider Name | Dr. Kevin Paul Chasse |
First Address | Dover Foxcroft, ME 04426-0067 |
Second Address | Dover Foxcroft, ME 04426-1323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 20/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208690000 | (05) | ME |
G27673 | (02) | ME |