Provider Demographics
NPI:1417228677
Name:EVERSAGE, BEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:EVERSAGE
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 1:28 GOOSE POND RD
Mailing Address - Street 2:
Mailing Address - City:SWANVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4386
Mailing Address - Country:US
Mailing Address - Phone:207-338-6032
Mailing Address - Fax:
Practice Address - Street 1:9 FIELD ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6661
Practice Address - Country:US
Practice Address - Phone:207-338-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor