Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 557 | ME |
NPI | 1003964123 |
---|---|
Provider Name | Dr. Richard N. Southiere |
First Address | Augusta, ME 04330-4804 |
Second Address | Augusta, ME 04330-4804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 31/10/2011 |