Debra A Tillou, D.C.
Individual provider Active NPI Chiropractor · Waldoboro, ME
NPI 1154534527 · NPPES record last updated Mar 3, 2008
Key facts
- NPI
- 1154534527
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CR875 (ME)
- Practice address
- 290 Bremen Rd
Waldoboro, ME 04572 - Phone
- (207) 832-6347
- Fax
- (207) 832-4664
- NPI assigned
- May 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CR875 | ME | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CR875 | ME | Yes |
Addresses
Primary practice location
290 Bremen Rd
Waldoboro, ME 04572
Mailing address
PO Box 625
Waldoboro, ME 04572-0625
Phone (207) 832-6347
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 129130099 | Medicaid | ME | |
| 022301 | Other | ANTHEM |
Other providers in Waldoboro, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.