Healthcare Provider Details

I. General information

NPI: 1578347373
Provider Name (Legal Business Name): MAINESTREAM HEALTH CO. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MAIN ST STE 6
GRAY ME
04039-9454
US

IV. Provider business mailing address

15 MAIN ST STE 6
GRAY ME
04039-9454
US

V. Phone/Fax

Practice location:
  • Phone: 207-317-6770
  • Fax:
Mailing address:
  • Phone: 207-317-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM THOMAS BARTLETT
Title or Position: OWNER
Credential: DC
Phone: 207-317-6770