Provider Demographics
NPI:1588846828
Name:MARCOTTE FAMILY CHIROPRACTIC PA
Entity Type:Organization
Organization Name:MARCOTTE FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MARCOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-657-7101
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-0215
Mailing Address - Country:US
Mailing Address - Phone:207-657-7101
Mailing Address - Fax:207-657-7165
Practice Address - Street 1:20 SHAKER RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-0215
Practice Address - Country:US
Practice Address - Phone:207-657-7101
Practice Address - Fax:207-657-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME175150000Medicaid
ME175150000Medicaid