Provider Demographics
NPI:1275154544
Name:SUMMIT CHIROPRACTIC
Entity Type:Organization
Organization Name:SUMMIT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-404-1788
Mailing Address - Street 1:720 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04342-3401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:ME
Practice Address - Zip Code:04342-3401
Practice Address - Country:US
Practice Address - Phone:207-404-1788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty