Provider Demographics
NPI:1659552180
Name:KEVIN CHASSE DC, PA
Entity Type:Organization
Organization Name:KEVIN CHASSE DC, PA
Other - Org Name:DOVER FOXCROFT CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CHASSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-564-2211
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-0067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1323
Practice Address - Country:US
Practice Address - Phone:207-564-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME350024329OtherPALMETTO MEDICARE
MEM2072OtherCIGNA
ME047926OtherANTHEM BLUECROSS BLUESHIE
ME208690000Medicaid
ME2649247OtherAETNA
MEME1126Medicare PIN