Provider Demographics
NPI:1326251547
Name:SULLOWAY, STEWART ESTABROOK (DC)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:ESTABROOK
Last Name:SULLOWAY
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 1:55 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1230
Mailing Address - Country:US
Mailing Address - Phone:207-647-3504
Mailing Address - Fax:207-647-5862
Practice Address - Street 1:55 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1230
Practice Address - Country:US
Practice Address - Phone:207-647-3504
Practice Address - Fax:207-647-5862
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR755111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
M20915OtherCIGNA
234252OtherAETNA
ME039429OtherBCBS
ME039429OtherBCBS
MM2418Medicare ID - Type Unspecified