Provider Demographics
NPI:1841527595
Name:NADEAU ACTIVE-FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:NADEAU ACTIVE-FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NADEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-289-6400
Mailing Address - Street 1:360 US ROUTE 1
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-6700
Mailing Address - Country:US
Mailing Address - Phone:207-289-6400
Mailing Address - Fax:866-289-1877
Practice Address - Street 1:360 US ROUTE 1
Practice Address - Street 2:SUITE 201
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-6700
Practice Address - Country:US
Practice Address - Phone:207-289-6400
Practice Address - Fax:866-289-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1913111N00000X
MECR1837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty