Provider Demographics
NPI:1578736583
Name:CORNISH FAMILY CHIROPRACTIC PA,
Entity Type:Organization
Organization Name:CORNISH FAMILY CHIROPRACTIC PA,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:SHAW
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-625-8100
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:CORNISH
Mailing Address - State:ME
Mailing Address - Zip Code:04020-0466
Mailing Address - Country:US
Mailing Address - Phone:207-625-8100
Mailing Address - Fax:207-625-8900
Practice Address - Street 1:202 MAPLE ST
Practice Address - Street 2:SUITE A
Practice Address - City:CORNISH
Practice Address - State:ME
Practice Address - Zip Code:04020
Practice Address - Country:US
Practice Address - Phone:207-625-8100
Practice Address - Fax:207-625-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME052042378ME02OtherANTHEM BLUE CROSS
ME1336109271OtherINDIVIDUAL PRACTITIONER N.P.I.
MEAA10887OtherHARVARD PILGRIM HEALTCARE
ME061116OtherANTHEM BLUE CROSS
MEMM9658Medicare UPIN
MEAA10887OtherHARVARD PILGRIM HEALTCARE