Provider Demographics
NPI:1548329444
Name:BARDWELL, KEVIN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:BARDWELL
Suffix:
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 1:40 FOREST FALLS DR
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6905
Mailing Address - Country:US
Mailing Address - Phone:207-846-1665
Mailing Address - Fax:207-591-4384
Practice Address - Street 1:40 FOREST FALLS DR
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6905
Practice Address - Country:US
Practice Address - Phone:207-846-1665
Practice Address - Fax:207-591-4384
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEU80301Medicare UPIN
MEMM8289Medicare ID - Type Unspecified