Provider Demographics
NPI: | 1760629141 |
---|---|
Name: | STONE COAST CHIROPRACTIC |
Entity Type: | Organization |
Organization Name: | STONE COAST CHIROPRACTIC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIROPRACTOR/PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RACHEL |
Authorized Official - Middle Name: | ANNE |
Authorized Official - Last Name: | STREIT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 207-781-7999 |
Mailing Address - Street 1: | 52 CENTER ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PORTLAND |
Mailing Address - State: | ME |
Mailing Address - Zip Code: | 04101-3902 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 207-781-7999 |
Mailing Address - Fax: | 297-781-0941 |
Practice Address - Street 1: | 52 CENTER ST |
Practice Address - Street 2: | |
Practice Address - City: | PORTLAND |
Practice Address - State: | ME |
Practice Address - Zip Code: | 04101-3902 |
Practice Address - Country: | US |
Practice Address - Phone: | 207-781-7999 |
Practice Address - Fax: | 297-781-0941 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-01-07 |
Last Update Date: | 2015-01-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ME | CR1764 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |