Provider Demographics
NPI:1689691131
Name:WEST, PAUL K (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:WEST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-4705
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:04967-4705
Practice Address - Country:US
Practice Address - Phone:207-487-5956
Practice Address - Fax:207-487-6044
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME119950000Medicaid
MEWEMM0195Medicare ID - Type Unspecified
ME119950000Medicaid