Provider Demographics
NPI:1235476011
Name:SPG PC
Entity Type:Organization
Organization Name:SPG PC
Other - Org Name:BACK ON TRACK WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LITTLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-899-0806
Mailing Address - Street 1:260 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2432
Mailing Address - Country:US
Mailing Address - Phone:207-899-0806
Mailing Address - Fax:
Practice Address - Street 1:260 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2432
Practice Address - Country:US
Practice Address - Phone:207-899-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty