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210 Western Ave Ste 300, South Portland, ME 04106-2426 | |
(207) 775-7468 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Clinic/center |
Location | 210 Western Ave Ste 300, South Portland, Maine |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1528770609 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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111N00000X | Chiropractor | (* (Not Available)) | Secondary |
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Rachel Kelli Fogarty |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1477908887 PECOS PAC ID: 6800187345 Enrollment ID: I20160614001018 |
Provider Name | Bea Margarita Serrano |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1134909476 PECOS PAC ID: 7618328840 Enrollment ID: I20240111002882 |
Mailing Address | Practice Location Address |
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210 Western Ave Ste 300, South Portland, ME 04106-2426 Ph: () - | 210 Western Ave Ste 300, South Portland, ME 04106-2426 Ph: (207) 775-7468 |