Individual
DR. HEATHER ANNA THERIAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
358 MAIN ST, GORHAM, ME 04038-1314
(207) 222-2118
(207) 222-2145
Mailing address
358 MAIN ST, GORHAM, ME 04038-1314
(207) 222-2118
(207) 222-2145
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CR2010
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002091902
MEDICARE PTAN
ME
Enumeration date
02/10/2011
Last updated
07/24/2013
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