Provider Demographics
NPI:1982142048
Name:207 CHIROPRACTIC PAIN CENTER, LLC
Entity type:Organization
Organization Name:207 CHIROPRACTIC PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-307-7413
Mailing Address - Street 1:43 COLUMBIA ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6346
Mailing Address - Country:US
Mailing Address - Phone:207-307-7413
Mailing Address - Fax:844-813-8498
Practice Address - Street 1:43 COLUMBIA ST
Practice Address - Street 2:SUITE 11
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6346
Practice Address - Country:US
Practice Address - Phone:207-307-7413
Practice Address - Fax:844-813-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2341261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400300186Medicare PIN