Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CR2158 | ME |
N | 111N00000X | Chiropractor | DCP00625 | RI |
Y | 111NN0400X | Neurology | CR2158 | ME |
NPI | 1174967038 |
---|---|
Provider Name | Haley Blake Girard |
First Address | Portland, ME 04102-2715 |
Second Address | Portland, ME 04102-2715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 03/12/2019 |