Provider Demographics
NPI:1053478552
Name:FERNALD, JOEL AARON (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:AARON
Last Name:FERNALD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:16 JONESBROOK CROSSING
Mailing Address - City:SOUTH CHINA
Mailing Address - State:ME
Mailing Address - Zip Code:04358
Mailing Address - Country:US
Mailing Address - Phone:207-445-4663
Mailing Address - Fax:866-573-8515
Practice Address - Street 1:16 JONESBROOK CROSSING
Practice Address - Street 2:
Practice Address - City:SOUTH CHINA
Practice Address - State:ME
Practice Address - Zip Code:04358
Practice Address - Country:US
Practice Address - Phone:207-445-4663
Practice Address - Fax:866-573-8515
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00310456OtherRAILROAD MEDICARE
ME100016OtherANTHEM
P00310456OtherRAILROAD MEDICARE
ME1772Medicare ID - Type Unspecified