Provider Demographics
NPI:1932148079
Name:LYNCH, ROBERT PETER JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PETER
Last Name:LYNCH
Suffix:JR
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 1:1200 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5652
Mailing Address - Country:US
Mailing Address - Phone:207-799-2263
Mailing Address - Fax:207-799-7112
Practice Address - Street 1:1200 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5652
Practice Address - Country:US
Practice Address - Phone:207-799-2263
Practice Address - Fax:207-799-7112
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000155OtherANTHEM
T31573Medicare UPIN
ME083488Medicare ID - Type Unspecified