Provider Demographics
NPI:1881709277
Name:NESIBA, BOB G (DC)
Entity type:Individual
Prefix:DR
First Name:BOB
Middle Name:G
Last Name:NESIBA
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 1:150 BUCKSPORT RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2224
Mailing Address - Country:US
Mailing Address - Phone:207-667-4678
Mailing Address - Fax:207-843-6059
Practice Address - Street 1:150 BUCKSPORT RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2224
Practice Address - Country:US
Practice Address - Phone:207-667-4678
Practice Address - Fax:207-843-6059
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR430111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MET31587Medicare UPIN
ME099481Medicare ID - Type Unspecified