Provider Demographics
NPI:1619140381
Name:DAMARISCOTTA CHIROPRACTIC
Entity Type:Organization
Organization Name:DAMARISCOTTA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:GIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-563-5500
Mailing Address - Street 1:PO BOX 1117
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-1117
Mailing Address - Country:US
Mailing Address - Phone:207-563-5500
Mailing Address - Fax:207-563-5580
Practice Address - Street 1:54 BRISTOL ROAD
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4025
Practice Address - Country:US
Practice Address - Phone:207-563-5500
Practice Address - Fax:207-563-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME643111N00000X
MECR643335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255467957OtherNPI
MEMM0599Medicare PIN
1255467957OtherNPI