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Individual

MICHAEL G GOULDING

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
12 REVERE ST, PORTLAND, ME 04103-4410
(207) 775-6782
(207) 775-3750
Mailing address
12 REVERE ST, PORTLAND, ME 04103-4410
(207) 775-6782
(207) 775-3750

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CR669
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0005433260
AETNA
ME
01
000822
ANTHEM
ME
01
1025479
AMERICAN REPUBLIC
ME
05
118550099
ME
01
350018055
RAILROAD MEDICARE
01
354401000
US DEPT DFEC
01
5611164
CIGNA
ME
01
V06225
HARVARD
ME
Enumeration date
08/10/2006
Last updated
10/14/2011
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