Provider Demographics
NPI:1083756241
Name:CHIROPRACTIC MOBILE SERVICES,LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC MOBILE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-522-6801
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-0538
Mailing Address - Country:US
Mailing Address - Phone:207-522-6801
Mailing Address - Fax:207-221-1299
Practice Address - Street 1:18 DEER HL N
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6368
Practice Address - Country:US
Practice Address - Phone:207-522-6801
Practice Address - Fax:207-221-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAA35816OtherHARVARD PILGRIM PROVIDER
ME061478OtherANTHEM BCBSME PROVIDER ID
ME2076096OtherCIGNA PROVIDER ID
ME7786093OtherAETNA PROVIDER ID
MEAA35816OtherHARVARD PILGRIM PROVIDER
MEME1549Medicare PIN