Provider Demographics
NPI:1528224748
Name:OUELLETTE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:OUELLETTE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DENIS
Authorized Official - Last Name:OUELLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-521-0286
Mailing Address - Street 1:49 COURT ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-2019
Mailing Address - Country:US
Mailing Address - Phone:207-521-0286
Mailing Address - Fax:207-521-0284
Practice Address - Street 1:49 COURT ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-2019
Practice Address - Country:US
Practice Address - Phone:207-521-0286
Practice Address - Fax:207-521-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR0731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME350050261OtherRAILROAD MEDICARE
ME134470000Medicaid
MEO39444OtherANTHEM BLUE CROSS BLUE SHIELD
MEO39444OtherANTHEM BLUE CROSS BLUE SHIELD
ME134470000Medicaid