Provider Demographics
NPI:1750628699
Name:MEND HEALTH OF MAINE
Entity Type:Organization
Organization Name:MEND HEALTH OF MAINE
Other - Org Name:PHYSICALLY SOUND PERFORMANCE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ST JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-289-6005
Mailing Address - Street 1:PO BOX 1161
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04070-1161
Mailing Address - Country:US
Mailing Address - Phone:207-289-6005
Mailing Address - Fax:
Practice Address - Street 1:560 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9743
Practice Address - Country:US
Practice Address - Phone:207-289-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2387111N00000X
CA31326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty