Provider Demographics
NPI:1255438602
Name:MCBRIDE, JENNIFER JACQUES (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JACQUES
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JACQUES
Other - Last Name:BRINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:597 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5412
Mailing Address - Country:US
Mailing Address - Phone:207-774-7242
Mailing Address - Fax:207-871-8041
Practice Address - Street 1:597 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5412
Practice Address - Country:US
Practice Address - Phone:207-774-7242
Practice Address - Fax:207-871-8041
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432568800Medicaid
ME432568800Medicaid