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NPI Code Detail

MEDICARE: DR. BERT J. DAIGLE C.C.S.P,,P.A.

MEDICARE: DR. BERT J. DAIGLE C.C.S.P,,P.A.
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
1111N00000XChiropractor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1017363OTHERMEANTHEM

General Provider Information

NPI Number : 1790942654
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. BERT J. DAIGLE C.C.S.P,,P.A.
Provider Business Mailing Address
First Line : 1008 LISBON ST
Second Line :
City : LEWISTON
State : ME
Zip : 04240-5721
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 : 04240-5721
Country : US
Telephone Number : 207-784-2049
Fax Number : 207-784-8562
Authorized Official
Title or Position : PRESIDENT
Name : DR. BERTHOL J DAIGLE
Credential : D.C.
Telephone Number : 207-784-2049
Provider Enumeration Date : 05/19/2008
Last Update Date : 05/20/2008

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