Provider Demographics
NPI:1831254010
Name:GREATER PORTLAND CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:GREATER PORTLAND CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-883-6630
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04070-0546
Mailing Address - Country:US
Mailing Address - Phone:207-883-6630
Mailing Address - Fax:207-883-5996
Practice Address - Street 1:400 ENTERPRISE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7639
Practice Address - Country:US
Practice Address - Phone:207-883-6630
Practice Address - Fax:207-883-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME040997OtherANTHEM PROVIDER ID
ME5547657OtherAETNA
ME1028021-001OtherCIGNA PAL
ME2972657OtherAETNA HMO
MEDJ63OtherHARVARD PILGRIM ID
MEM25719OtherCIGNA ID
MEDJ63OtherHARVARD PILGRIM ID