Provider Demographics
NPI:1124121702
Name:INTERPRACTIC INC
Entity type:Organization
Organization Name:INTERPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SAULTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-778-6464
Mailing Address - Street 1:116 NARROW GAUGE SQ
Mailing Address - Street 2:STE 102
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938
Mailing Address - Country:US
Mailing Address - Phone:207-778-6464
Mailing Address - Fax:207-778-0011
Practice Address - Street 1:116 NARROW GAUGE SQ
Practice Address - Street 2:STE 102
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938
Practice Address - Country:US
Practice Address - Phone:207-778-6464
Practice Address - Fax:207-778-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM7653Medicare ID - Type Unspecified