Provider Demographics
NPI:1710023460
Name:MOUNTAINVIEW CHIROPRACTIC AND KINESIOLOGY
Entity type:Organization
Organization Name:MOUNTAINVIEW CHIROPRACTIC AND KINESIOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STE MARIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-684-9707
Mailing Address - Street 1:PO BOX 298 32 HILL STREET
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05828
Mailing Address - Country:US
Mailing Address - Phone:802-684-9707
Mailing Address - Fax:802-684-9707
Practice Address - Street 1:32 HILL STREET
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VT
Practice Address - Zip Code:05828
Practice Address - Country:US
Practice Address - Phone:802-684-9707
Practice Address - Fax:802-684-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060001116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
24571104OtherCBA
5705962OtherFIRST HEALTH
674860OtherCIGNA
05400894VT01OtherBC BS OF NH
DANV59218 59219OtherBC BS
674860OtherCIGNA