Provider Demographics
NPI:1326120890
Name:MJW CORPORATION
Entity Type:Organization
Organization Name:MJW CORPORATION
Other - Org Name:WINDHAM CHIROPRACTIC AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WASOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-892-9001
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-0787
Mailing Address - Country:US
Mailing Address - Phone:207-892-9001
Mailing Address - Fax:207-892-3228
Practice Address - Street 1:585 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4908
Practice Address - Country:US
Practice Address - Phone:207-892-9001
Practice Address - Fax:207-892-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0452064OtherCIGNA
043148OtherANTHEM
=========OtherTIN