Provider Demographics
NPI:1396074431
Name:GARDINER FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:GARDINER FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:PIDGEON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-582-2222
Mailing Address - Street 1:90 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2176
Mailing Address - Country:US
Mailing Address - Phone:207-582-2222
Mailing Address - Fax:207-588-0891
Practice Address - Street 1:90 MAINE AVE
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-2176
Practice Address - Country:US
Practice Address - Phone:207-582-2222
Practice Address - Fax:207-588-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME2407Medicare PIN