Provider Demographics
NPI:1215407630
Name:MAINE, NATHAN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:THOMAS
Last Name:MAINE
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 1:319 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3856
Mailing Address - Country:US
Mailing Address - Phone:281-446-1242
Mailing Address - Fax:
Practice Address - Street 1:319 1ST ST E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3856
Practice Address - Country:US
Practice Address - Phone:281-446-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor