Benjamin James Goudreau, D.C.
Individual provider Active NPI Chiropractor · Portland, ME
NPI 1649679457 · NPPES record last updated Jan 7, 2020
Key facts
- NPI
- 1649679457
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CR2383 (ME)
- Practice address
- 222 Auburn St Ste 102
Portland, ME 04103-6005 - Phone
- (508) 742-5037
- NPI assigned
- Aug 18, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| CR2383 | ME | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Capitol Chiropractic Inc. | Chiropractor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CR2383 | ME | Yes |
Addresses
Primary practice location
222 Auburn St Ste 102
Portland, ME 04103-6005
Mailing address
63 Greenwood LN
Portland, ME 04103-1609
Phone (508) 742-5037
Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2020. 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.