Provider Demographics
NPI:1114009974
Name:WELLNESS & CHIROPRACTIC CARE, LLC, PA
Entity Type:Organization
Organization Name:WELLNESS & CHIROPRACTIC CARE, LLC, PA
Other - Org Name:HAGERTY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-729-8656
Mailing Address - Street 1:298 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3314
Mailing Address - Country:US
Mailing Address - Phone:207-729-8656
Mailing Address - Fax:207-729-7471
Practice Address - Street 1:298 MAINE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3314
Practice Address - Country:US
Practice Address - Phone:207-729-8656
Practice Address - Fax:207-729-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9755Medicare ID - Type UnspecifiedMEDICARE GROUP ID
MEU39976Medicare UPIN