Provider Demographics
NPI:1265570857
Name:DE MAERTELAERE, GEORGE PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PAUL
Last Name:DE MAERTELAERE
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 1:304 HANCOCK ST
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6573
Mailing Address - Country:US
Mailing Address - Phone:207-990-5711
Mailing Address - Fax:207-990-5712
Practice Address - Street 1:304 HANCOCK ST
Practice Address - Street 2:SUITE 2G
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6573
Practice Address - Country:US
Practice Address - Phone:207-990-5711
Practice Address - Fax:207-990-5712
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM2344Medicare ID - Type Unspecified
MET79485Medicare UPIN