Provider Demographics
NPI:1407958127
Name:COMEFORD, TIMOTHY J (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:COMEFORD
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:PO BOX 496
Mailing Address - Street 2:COMEFORD CHIROPRACTIC CENTER
Mailing Address - City:BELGRADE LAKES
Mailing Address - State:ME
Mailing Address - Zip Code:04918
Mailing Address - Country:US
Mailing Address - Phone:207-495-3877
Mailing Address - Fax:
Practice Address - Street 1:34 AUGUSTA ROAD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:ME
Practice Address - Zip Code:04918
Practice Address - Country:US
Practice Address - Phone:207-495-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME024147OtherANTHEM
ME128880000Medicaid
ME024147OtherANTHEM
U47644Medicare UPIN