Provider Demographics
NPI:1023566650
Name:BICKFORD, KIMBERLY R (LAC DIPL OM)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:R
Last Name:BICKFORD
Suffix:
Gender:F
Credentials:LAC DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-9503
Mailing Address - Country:US
Mailing Address - Phone:207-312-4237
Mailing Address - Fax:
Practice Address - Street 1:1278 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:ME
Practice Address - Zip Code:04071-6604
Practice Address - Country:US
Practice Address - Phone:207-312-4237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME7551288171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist