Provider Demographics
NPI:1205155611
Name:OSTEOPATHIC WELLNESS LLC
Entity type:Organization
Organization Name:OSTEOPATHIC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-615-6956
Mailing Address - Street 1:94 AUBURN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2141
Mailing Address - Country:US
Mailing Address - Phone:207-615-6956
Mailing Address - Fax:207-850-2228
Practice Address - Street 1:94 AUBURN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2141
Practice Address - Country:US
Practice Address - Phone:207-615-6956
Practice Address - Fax:207-850-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2056204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty