Provider Demographics
NPI:1043310980
Name:METCALF, DAVID JAMES (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:METCALF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 US ROUTE 202
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364
Mailing Address - Country:US
Mailing Address - Phone:207-377-2151
Mailing Address - Fax:
Practice Address - Street 1:1354 US ROUTE 202
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-3821
Practice Address - Country:US
Practice Address - Phone:207-377-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04546111N00000X
MECR2252111N00000X
TX10690111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100327400AMedicaid
60020Medicare ID - Type Unspecified
U73776Medicare UPIN