Provider Demographics
NPI:1598998916
Name:WEST CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WEST CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-487-5956
Mailing Address - Street 1:221 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967
Mailing Address - Country:US
Mailing Address - Phone:207-487-5956
Mailing Address - Fax:207-487-6044
Practice Address - Street 1:221 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967
Practice Address - Country:US
Practice Address - Phone:207-487-5956
Practice Address - Fax:207-487-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME119950000Medicaid
ME119950000Medicaid
MEMM0195Medicare PIN