1831254010 NPI number — GREATER PORTLAND CHIROPRACTIC, INC.

Table of content: (NPI 1831254010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831254010 NPI number — GREATER PORTLAND CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER PORTLAND CHIROPRACTIC, INC.
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:
Provider Other Organization Name Type Code:
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:
1831254010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 546
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCARBOROUGH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04070-0546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-883-6630
Provider Business Mailing Address Fax Number:
207-883-5996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 ENTERPRISE DR
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SCARBOROUGH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04074-7639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-883-6630
Provider Business Practice Location Address Fax Number:
207-883-5996
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAYER
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
207-883-6630

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CR1095 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 040997 . This is a "ANTHEM PROVIDER ID" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 5547657 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1028021-001 . This is a "CIGNA PAL" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2972657 . This is a "AETNA HMO" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: DJ63 . This is a "HARVARD PILGRIM ID" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: M25719 . This is a "CIGNA ID" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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