Individual
DR. GARRETT RUSSELL LEWELLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
50 COVE ST, SUITE A, PORTLAND, ME 04101-2514
(207) 828-8777
(207) 828-8778
Mailing address
50 COVE ST, SUITE A, PORTLAND, ME 04101-2514
(207) 828-8777
(207) 828-8778
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
2460
MA
111N00000X
Chiropractor
Primary
CR1311
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022072
ANTHEM PROVIDER NUMBER
ME
01
—
1092630
AETNA PROVIDER NUMBER
ME
01
—
1255431755
MEDICARE PTAN UX2253
ME
01
—
351404
HARVARD PILGRAM PROVIDER
ME
01
—
55-0850500
MARCHIGONNE PROVIDER #
ME
01
—
8546678
CIGNA PROVIDER #
ME
Enumeration date
09/24/2006
Last updated
11/30/2015
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