Provider Demographics
NPI:1144402223
Name:BOULET-STEELE CHIROPRACTIC & ACUPUNCTURE CENTER, P.A.
Entity Type:Organization
Organization Name:BOULET-STEELE CHIROPRACTIC & ACUPUNCTURE CENTER, P.A.
Other - Org Name:BOULET-STEELE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOULET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-782-1171
Mailing Address - Street 1:675 MAIN ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5802
Mailing Address - Country:US
Mailing Address - Phone:207-278-2117
Mailing Address - Fax:207-782-6176
Practice Address - Street 1:675 MAIN ST
Practice Address - Street 2:SUITE 18
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5802
Practice Address - Country:US
Practice Address - Phone:207-278-2117
Practice Address - Fax:207-782-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEBOMM5013Medicare PIN