Healthcare Provider Details

I. General information

NPI: 1821507138
Provider Name (Legal Business Name): ANTONY KEITH ANGUS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MAIN ST
OLD TOWN ME
04468-1470
US

IV. Provider business mailing address

227 MAIN ST
OLD TOWN ME
04468-1470
US

V. Phone/Fax

Practice location:
  • Phone: 12078275951
  • Fax: 120-782-7595
Mailing address:
  • Phone: 12078275951
  • Fax: 120-782-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCRA2501
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR2351
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: