Provider Demographics
NPI:1588796262
Name:CHANEY, MARY C (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:CHANEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-7302
Mailing Address - Country:US
Mailing Address - Phone:207-200-6692
Mailing Address - Fax:
Practice Address - Street 1:202 US ROUTE 1 SUITE 203
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-200-6692
Practice Address - Fax:207-781-7882
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC#132171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME060847OtherANTHEM PIN #
ME464702613OtherEIN NUMBER FOR MARY CHANEY LLC, P.A.