Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2455 | MA |
N | 111N00000X | Chiropractor | CR1393 | ME |
NPI | 1003993627 |
---|---|
Provider Name | Dr. Amy Mooney Lewellen |
First Address | Portland, ME 04101-2514 |
Second Address | Portland, ME 04101-2514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 30/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022182 | ANTHEM BCBS (01) | ME |
0630793200 | CIGNA (01) | MA |
1003993627 | MEDCARE PTAN UX2254 (01) | ME |
1049468 | ASHN (01) | MA |
2146577 | FIRST HEALTH (01) | MA |
2503521 | AETNA (01) | MA |
351399 | HPHC (01) | MA |
4402698 | ACN (01) | MA |
Y36775 | BLUECROSS (01) | MA |