Provider Demographics
NPI:1891901252
Name:GAUTHAMA THOMPSON, RIVER VALLEY CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:GAUTHAMA THOMPSON, RIVER VALLEY CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAUTHAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-364-7931
Mailing Address - Street 1:344 HANCOCK ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-1937
Mailing Address - Country:US
Mailing Address - Phone:207-364-7931
Mailing Address - Fax:207-364-3644
Practice Address - Street 1:344 HANCOCK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-1937
Practice Address - Country:US
Practice Address - Phone:207-364-7931
Practice Address - Fax:207-364-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME328880099Medicaid
ME1042297OtherAETNA
MEM23278OtherCIGNA
ME024970OtherANTHEM BCBS
MEMM6632Medicare ID - Type Unspecified
ME328880099Medicaid