Provider Demographics
NPI:1164896262
Name:FRIDGEN CHIROPRACTIC PA
Entity Type:Organization
Organization Name:FRIDGEN CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUDSON-FRIDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-883-1515
Mailing Address - Street 1:342 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9774
Mailing Address - Country:US
Mailing Address - Phone:207-883-1515
Mailing Address - Fax:207-883-1536
Practice Address - Street 1:342 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9774
Practice Address - Country:US
Practice Address - Phone:207-883-1515
Practice Address - Fax:207-883-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty