Provider Demographics
NPI:1184343048
Name:BUCHANAN, KRISTI (LMT, CHT)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LMT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MAIN ST # 77
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6397
Mailing Address - Country:US
Mailing Address - Phone:207-944-4387
Mailing Address - Fax:207-990-5505
Practice Address - Street 1:61 MAIN ST # 77
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6397
Practice Address - Country:US
Practice Address - Phone:207-944-4387
Practice Address - Fax:207-990-5505
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT1504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist