Provider Demographics
NPI:1649312885
Name:NOONAN CHIROPRACTIC
Entity type:Organization
Organization Name:NOONAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-827-5951
Mailing Address - Street 1:227 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-1470
Mailing Address - Country:US
Mailing Address - Phone:207-827-5951
Mailing Address - Fax:207-827-0260
Practice Address - Street 1:227 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-1470
Practice Address - Country:US
Practice Address - Phone:207-827-5951
Practice Address - Fax:207-827-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME113280000Medicaid
ME113280000Medicaid