Provider Demographics
NPI:1114108115
Name:FAMILY CHIROPRACTIC OF KENNEBUNK, PA
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC OF KENNEBUNK, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:P
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-985-8877
Mailing Address - Street 1:44 YORK ST
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7160
Mailing Address - Country:US
Mailing Address - Phone:207-985-8877
Mailing Address - Fax:207-985-5683
Practice Address - Street 1:44 YORK ST
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7160
Practice Address - Country:US
Practice Address - Phone:207-985-8877
Practice Address - Fax:207-985-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-18
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEFAMM6055Medicare UPIN