Provider Demographics
NPI:1881654051
Name:ROBERTSON, JANE LOUISE (DC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:LOUISE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7571
Mailing Address - Country:US
Mailing Address - Phone:207-338-2024
Mailing Address - Fax:207-338-9900
Practice Address - Street 1:326 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7571
Practice Address - Country:US
Practice Address - Phone:207-338-2024
Practice Address - Fax:207-338-9900
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEM23126OtherCIGNA
ME041429OtherANTHEM BC/BS
ME1042460OtherAETNA
MEMM6245OtherMEDICARE ID
ME041429OtherANTHEM BC/BS