Provider Demographics
NPI:1821199787
Name:PENOBSCOT BAY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:PENOBSCOT BAY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-596-5523
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:WEST ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04865-0092
Mailing Address - Country:US
Mailing Address - Phone:207-596-5523
Mailing Address - Fax:207-596-5655
Practice Address - Street 1:1112 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-3802
Practice Address - Country:US
Practice Address - Phone:207-596-5523
Practice Address - Fax:207-596-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty