Provider Demographics
NPI:1659542918
Name:HERITAGE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:HERITAGE FAMILY CHIROPRACTIC
Other - Org Name:HERITAGE INTEGRATIVE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-321-2100
Mailing Address - Street 1:80 LEIGHTON RD
Mailing Address - Street 2:STE B
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2242
Mailing Address - Country:US
Mailing Address - Phone:207-321-2100
Mailing Address - Fax:207-321-2101
Practice Address - Street 1:80 LEIGHTON ROAD
Practice Address - Street 2:STE B
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2242
Practice Address - Country:US
Practice Address - Phone:207-321-2100
Practice Address - Fax:207-321-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME043860OtherANTHEM
MEAA28305OtherHARVARD PILGRIM
MEM216561OtherCIGNA
ME3949217OtherAETNA
ME190080000Medicaid
ME190080000Medicaid
ME3949217OtherAETNA