MEDICARE: DR. MICHAEL R MARCOTTE D.C.

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	CR1361	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3692954	OTHER	ME	AETNA PROVIDER NUMBER
3	69304	OTHER	ME	CIGNA PROVIDER NUMBER
4	352502	OTHER	ME	HARVARD PILGRIM PROVIDER
5	061123	OTHER	ME	BC/BS PROVIDER ID

General Provider Information

NPI Number	:	1154385995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R MARCOTTE D.C.

Provider Business Mailing Address
First Line	:	20 SHAKER ROAD
Second Line	:	PO BOX 215
City	:	GRAY
State	:	ME
Zip	:	04039-9531
Country	:	US
Telephone Number	:	207-657-7101
Fax Number	:	207-657-7165

Provider Business Practice Location Address
First Line	:	20 SHAKER ROAD
Second Line	:
City	:	GRAY
State	:	ME
Zip	:	04039-9531
Country	:	US
Telephone Number	:	207-657-7101
Fax Number	:	207-657-7165

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	09/30/2013

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