Provider Demographics
NPI:1699853127
Name:VICTORIA CROCKETT-RICE DBA: BETHEL STATION CHIROPRACTIC OFFICE
Entity Type:Organization
Organization Name:VICTORIA CROCKETT-RICE DBA: BETHEL STATION CHIROPRACTIC OFFICE
Other - Org Name:BETHEL STATION CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT-RICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-824-3899
Mailing Address - Street 1:P.O. BOX 996
Mailing Address - Street 2:1 PARKWAY SUITE 201
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217
Mailing Address - Country:US
Mailing Address - Phone:207-824-3899
Mailing Address - Fax:207-824-7677
Practice Address - Street 1:1 PARKWAY SUITE 201
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217
Practice Address - Country:US
Practice Address - Phone:207-824-3899
Practice Address - Fax:207-824-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1055111N00000X
MA761111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131690000Medicaid
ME131690000Medicaid
MM9487Medicare ID - Type UnspecifiedGROUP