MEDICARE: DR. BERTHOL J DAIGLE 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	561	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	017363	OTHER		ANTHEM

General Provider Information

NPI Number	:	1770518805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERTHOL J DAIGLE DC

Provider Business Mailing Address
First Line	:	1008 LISBON ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240
Country	:	US
Telephone Number	:	207-784-2049
Fax Number	:	207-784-8562

Provider Business Practice Location Address
First Line	:	1008 LISBON ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240
Country	:	US
Telephone Number	:	207-784-2049
Fax Number	:	207-784-8562

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	05/20/2008

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