1841527595 NPI number — NADEAU ACTIVE-FAMILY CHIROPRACTIC

Table of content: (NPI 1841527595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841527595 NPI number — NADEAU ACTIVE-FAMILY CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NADEAU ACTIVE-FAMILY CHIROPRACTIC
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:
1841527595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 US ROUTE 1
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SCARBOROUGH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04074-6700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-289-6400
Provider Business Mailing Address Fax Number:
866-289-1877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 US ROUTE 1
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SCARBOROUGH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04074-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-289-6400
Provider Business Practice Location Address Fax Number:
866-289-1877
Provider Enumeration Date:
11/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NADEAU
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
207-289-6400

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CR1913 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: CR1837 , 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)





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