Provider Demographics
NPI:1073662193
Name:MICHAEL D & SHEILA H LITTLEFIELD
Entity Type:Organization
Organization Name:MICHAEL D & SHEILA H LITTLEFIELD
Other - Org Name:MALL ROAD CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:H
Authorized Official - Last Name:LITTLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-772-1031
Mailing Address - Street 1:118 MAINE MALL ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2309
Mailing Address - Country:US
Mailing Address - Phone:207-772-1031
Mailing Address - Fax:207-774-9394
Practice Address - Street 1:118 MAINE MALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2309
Practice Address - Country:US
Practice Address - Phone:207-772-1031
Practice Address - Fax:207-774-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR565111N00000X
MECR566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4404051OtherTAXONOMY
ME002305OtherBLUE CROSS BLUE SHEILD
ME111990099Medicaid
ME002304OtherBLUE CROSS BLUE SHEILD
ME111990199Medicaid
ME4404052OtherTAXONOMY
MEMM0100Medicare ID - Type Unspecified
MET31531Medicare UPIN
ME111990199Medicaid
ME002304OtherBLUE CROSS BLUE SHEILD