MEDICARE: DR. JOEL AARON FERNALD DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CR1592	ME

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00310456	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	100016	OTHER	ME	ANTHEM

General Provider Information

NPI Number	:	1053478552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL AARON FERNALD DC

Provider Business Mailing Address
First Line	:	PO BOX 86
Second Line	:	16 JONESBROOK CROSSING
City	:	SOUTH CHINA
State	:	ME
Zip	:	04358
Country	:	US
Telephone Number	:	207-445-4663
Fax Number	:	866-573-8515

Provider Business Practice Location Address
First Line	:	16 JONESBROOK CROSSING
Second Line	:
City	:	SOUTH CHINA
State	:	ME
Zip	:	04358
Country	:	US
Telephone Number	:	207-445-4663
Fax Number	:	866-573-8515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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