Provider Demographics
NPI:1497452411
Name:ALLEY, TRISTAN (DC)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:ALLEY
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 1:4 UNION PARK RD OFC 18
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1711
Mailing Address - Country:US
Mailing Address - Phone:207-200-3257
Mailing Address - Fax:
Practice Address - Street 1:164 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:ME
Practice Address - Zip Code:04357-4036
Practice Address - Country:US
Practice Address - Phone:207-737-2482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1881948768OtherMEDICARE
ME1881948768Medicaid