Provider Demographics
NPI:1164433553
Name:GOULDING, MICHAEL G (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:GOULDING
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 1:12 REVERE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4410
Mailing Address - Country:US
Mailing Address - Phone:207-775-6782
Mailing Address - Fax:207-775-3750
Practice Address - Street 1:12 REVERE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4410
Practice Address - Country:US
Practice Address - Phone:207-775-6782
Practice Address - Fax:207-775-3750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000822OtherANTHEM
354401000OtherUS DEPT DFEC
ME5611164OtherCIGNA
350018055OtherRAILROAD MEDICARE
ME1025479OtherAMERICAN REPUBLIC
ME0005433260OtherAETNA
ME118550099Medicaid
MEV06225OtherHARVARD
MEV06225OtherHARVARD