Provider Demographics
NPI:1225446586
Name:HAROLDSON HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:HAROLDSON HEALTH SERVICES LLC
Other - Org Name:TEN LAKES CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-647-9900
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-0020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4227
Practice Address - Country:US
Practice Address - Phone:207-647-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR 1910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty