Provider Demographics
NPI:1154385995
Name:MARCOTTE, MICHAEL R (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:MARCOTTE
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 1:20 SHAKER ROAD
Mailing Address - Street 2:PO BOX 215
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-9531
Mailing Address - Country:US
Mailing Address - Phone:207-657-7101
Mailing Address - Fax:207-657-7165
Practice Address - Street 1:20 SHAKER ROAD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9531
Practice Address - Country:US
Practice Address - Phone:207-657-7101
Practice Address - Fax:207-657-7165
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME175150099Medicaid
ME3692954OtherAETNA PROVIDER NUMBER
ME69304OtherCIGNA PROVIDER NUMBER
ME352502OtherHARVARD PILGRIM PROVIDER
ME061123OtherBC/BS PROVIDER ID
MEU95591Medicare UPIN
ME352502OtherHARVARD PILGRIM PROVIDER