Mid-Coast Spine & Sport LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

MID-COAST SPINE & SPORT LLC

Practice address

18 West St
Boothbay Harbor, ME 04538-1849

Phone

(207) 357-4541

NPI assigned

Jul 3, 2019

Last updated

Jun 17, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brady R Fergola, DCNPI 1982263976

Title

Owner

Phone

(207) 357-4541

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brady Robert Fergola, DC

  • Chiropractor
  • Boothbay Harbor, ME
  • NPI 1982263976
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1851953475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MARDEN RD",
            "city": "BOOTHBAY HARBOR",
            "state": "ME",
            "postal_code": "04538",
            "telephone_number": "207-357-4541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 WEST ST",
            "city": "BOOTHBAY HARBOR",
            "state": "ME",
            "postal_code": "045381849",
            "telephone_number": "207-357-4541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-COAST SPINE & SPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-03",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "FERGOLA",
        "authorized_official_first_name": "BRADY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-357-4541",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drbrady@boothbaychiro.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email or fax",
            "address_1": "18 West St",
            "city": "Boothbay Harbor",
            "state": "ME",
            "country_code": "US",
            "postal_code": "045381849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mainehealth (Gregory Wing at St. Andrews Village)
• Mainehealth (Safe Havens at St. Andrews Village)
• Mainehealth (Gregory Wing at St. Andrews Village)
• Mainehealth (MaineHealth John F Andrews Health Center)
• Shane Taylor McNear
• Miles Memorial Hospital (MMG Pediatrics-Boothbay A Department of Miles Memorial Hospital)
• David G Millay, M.D.
• Carrie L Mitchell, PTA
• Shingayi N Molai
• Elsie M Morgan, PHARMD

• Chiropractor in Boothbay Harbor, ME
• Providers in Boothbay Harbor, ME by specialty
• Chiropractor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.