Provider Demographics
NPI:1407977127
Name:PIDGEON, PAUL LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LAWRENCE
Last Name:PIDGEON
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 1:90 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2131
Mailing Address - Country:US
Mailing Address - Phone:207-582-2222
Mailing Address - Fax:207-588-0891
Practice Address - Street 1:90 MAINE AVE
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-2131
Practice Address - Country:US
Practice Address - Phone:207-582-2222
Practice Address - Fax:207-588-0891
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME005189OtherANTHEM BCBS
MEMM2639Medicare ID - Type Unspecified
ME005189OtherANTHEM BCBS