Provider Demographics
NPI:1689799074
Name:HENDRICKS, JAMES A (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:HENDRICKS
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 1:174 S FREEPORT RD
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6145
Mailing Address - Country:US
Mailing Address - Phone:207-865-1183
Mailing Address - Fax:207-865-1183
Practice Address - Street 1:174 S FREEPORT RD
Practice Address - Street 2:SUITE 1F
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6145
Practice Address - Country:US
Practice Address - Phone:207-865-1183
Practice Address - Fax:207-865-1183
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1492459OtherANTHEM
ME038032OtherAETNA
ME133220099Medicaid
ME133220099Medicaid
ME1492459OtherANTHEM