Provider Demographics
NPI:1457374803
Name:GARDINER FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:GARDINER FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIDGEON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-582-2222
Mailing Address - Street 1:90 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345
Mailing Address - Country:US
Mailing Address - Phone:207-582-2222
Mailing Address - Fax:207-588-0891
Practice Address - Street 1:90 MAIN AVE
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345
Practice Address - Country:US
Practice Address - Phone:207-582-2222
Practice Address - Fax:207-588-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR719111N00000X
MECR715111N00000X
MECR1261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T86552Medicare UPIN
MEMM2639Medicare ID - Type Unspecified