1073662193 NPI number — MICHAEL D & SHEILA H LITTLEFIELD

Table of content: (NPI 1073662193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073662193 NPI number — MICHAEL D & SHEILA H LITTLEFIELD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL D & SHEILA H LITTLEFIELD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MALL ROAD CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073662193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 MAINE MALL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04106-2309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-772-1031
Provider Business Mailing Address Fax Number:
207-774-9394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 MAINE MALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04106-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-772-1031
Provider Business Practice Location Address Fax Number:
207-774-9394
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LITTLEFIELD
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
207-772-1031

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CR565 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: CR566 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4404051 . This is a "TAXONOMY" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 002305 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 111990099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002304 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 111990199 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4404052 . This is a "TAXONOMY" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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