Provider Demographics
NPI:1770907545
Name:MAINE ADVANCED SPINAL CARE LLC
Entity type:Organization
Organization Name:MAINE ADVANCED SPINAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:NEIVERTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-985-2428
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-0848
Mailing Address - Country:US
Mailing Address - Phone:207-985-2428
Mailing Address - Fax:207-985-2466
Practice Address - Street 1:2550 POST RD
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-2550
Practice Address - Country:US
Practice Address - Phone:207-985-2428
Practice Address - Fax:207-985-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXAWHY1Medicare PIN
NYU79254Medicare UPIN