Provider Demographics
NPI:1114135480
Name:DEMERS, MICHAEL R (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:DEMERS
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 1:114 TILLSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-3424
Mailing Address - Country:US
Mailing Address - Phone:207-594-4104
Mailing Address - Fax:207-594-0699
Practice Address - Street 1:114 TILLSON AVE
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3424
Practice Address - Country:US
Practice Address - Phone:207-594-4104
Practice Address - Fax:207-594-0699
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM0991Medicare ID - Type UnspecifiedCHIROPRACTOR