Provider Demographics
NPI:1437181500
Name:HOUSTON, MICHELLE RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RAE
Last Name:HOUSTON
Suffix:
Gender:F
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 1063
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1063
Mailing Address - Country:US
Mailing Address - Phone:207-664-0013
Mailing Address - Fax:207-664-0564
Practice Address - Street 1:97 BEECHLAND RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2540
Practice Address - Country:US
Practice Address - Phone:207-664-0013
Practice Address - Fax:207-664-0564
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431592500Medicaid
ME431592500Medicaid
MEME 0435Medicare PIN