Provider Demographics
NPI:1568647766
Name:ROBERTSON CHIROPRACTIC PA
Entity Type:Organization
Organization Name:ROBERTSON CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-338-2024
Mailing Address - Street 1:326 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7571
Mailing Address - Country:US
Mailing Address - Phone:207-338-2024
Mailing Address - Fax:207-338-9900
Practice Address - Street 1:326 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7571
Practice Address - Country:US
Practice Address - Phone:207-338-2024
Practice Address - Fax:207-338-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1042460OtherAETNA
MEM23126OtherCIGNA
MEMM9309OtherMEDICARE ID
ME041429OtherANTHEM BC/BS
MEU63206Medicare UPIN