Provider Demographics
NPI:1497876320
Name:NEWPORT CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:NEWPORT CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER S CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAULTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-368-4318
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-0367
Mailing Address - Country:US
Mailing Address - Phone:207-368-4318
Mailing Address - Fax:207-368-5224
Practice Address - Street 1:8 MAIN ST
Practice Address - Street 2:SUITE S
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4157
Practice Address - Country:US
Practice Address - Phone:207-368-4318
Practice Address - Fax:207-368-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME10903690OtherCAQH PROVIDER NUMBER
ME015712OtherANTHEM BC BS
MECM2240OtherRR MEDICARE GROUP ID
MEM22331OtherCIGNA HEALTH CARE
ME1042422OtherAETNA
MEMNT164OtherHARVARD PILGRIM
ME0000418OtherMEDICARE GROUP ID
ME129380000Medicaid
ME350029711OtherRR MEDICARE, PALMETTO GBA
ME10903690OtherCAQH PROVIDER NUMBER
MEMNT164OtherHARVARD PILGRIM