MEDICARE: MOUNTAINVIEW CHIROPRACTIC AND KINESIOLOGY

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	0060001116	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	24571104	OTHER	CBA
2	5705962	OTHER	FIRST HEALTH
3	674860	OTHER	CIGNA
4	05400894VT01	OTHER	BC BS OF NH
5	DANV59218 59219	OTHER	BC BS

General Provider Information

NPI Number	:	1710023460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAINVIEW CHIROPRACTIC AND KINESIOLOGY

Provider Business Mailing Address
First Line	:	PO BOX 298 32 HILL STREET
Second Line	:
City	:	DANVILLE
State	:	VT
Zip	:	05828
Country	:	US
Telephone Number	:	802-684-9707
Fax Number	:	802-684-9707

Provider Business Practice Location Address
First Line	:	32 HILL STREET
Second Line	:
City	:	DANVILLE
State	:	VT
Zip	:	05828
Country	:	US
Telephone Number	:	802-684-9707
Fax Number	:	802-684-9707

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEREMY STE MARIE
Credential	:	DC
Telephone Number	:	802-684-9707

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	12/13/2016

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Directions to “MOUNTAINVIEW CHIROPRACTIC AND KINESIOLOGY ” Practice Location

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